an ethical framework for organizational resource

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Duquesne University Duquesne Scholarship Collection Electronic eses and Dissertations Spring 5-11-2018 An Ethical Framework for Organizational Resource Allocation for Patient Services in Health Care Natalie Dick Follow this and additional works at: hps://dsc.duq.edu/etd Part of the Bioethics and Medical Ethics Commons is One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic eses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. Recommended Citation Dick, N. (2018). An Ethical Framework for Organizational Resource Allocation for Patient Services in Health Care (Doctoral dissertation, Duquesne University). Retrieved from hps://dsc.duq.edu/etd/1458

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Page 1: An Ethical Framework for Organizational Resource

Duquesne UniversityDuquesne Scholarship Collection

Electronic Theses and Dissertations

Spring 5-11-2018

An Ethical Framework for Organizational ResourceAllocation for Patient Services in Health CareNatalie Dick

Follow this and additional works at: https://dsc.duq.edu/etd

Part of the Bioethics and Medical Ethics Commons

This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in ElectronicTheses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please [email protected].

Recommended CitationDick, N. (2018). An Ethical Framework for Organizational Resource Allocation for Patient Services in Health Care (Doctoraldissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1458

Page 2: An Ethical Framework for Organizational Resource

AN ETHICAL FRAMEWORK FOR ORGANIZATIONAL RESOURCE

ALLOCATION FOR PATIENT SERVICES IN HEALTH CARE

A Dissertation

Submitted to the McAnulty College and Graduate School of Liberal Arts

Duquesne University

In partial fulfillment of the requirements for

the degree of Doctor of Philosophy

By

Natalie Dick

May 2018

 

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Copyright by

Natalie Dick

2018

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AN ETHICAL FRAMEWORK FOR ORGANIZATIONAL RESOURCE ALLOCATION FOR

PATIENT SERVICES IN HEALTH CARE

By

Natalie Dick Approved March 22, 2018

__________________________ ________________________ Gerald Magill, Ph.D. Henk Ten Have, M.D., Ph.D. Vernon F. Gallagher Chair Director, Center for Healthcare Ethics Professor of Healthcare Ethics (Committee Member) __________________________ ________________________ Joris Gielen, Ph.D. Henk Ten Have, M.D., Ph.D. Assistant Professor, Director, Center for Healthcare Ethics Center for Healthcare Ethics (Committee Member) (Committee Member) ____________________________ James Swindal, Ph.D. Professor and Dean of McAnulty College McAnulty College and Graduate School of Liberal Arts

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ABSTRACT

AN ETHICAL FRAMEWORK FOR ORGANIZATIONAL RESOURCE ALLOCATION FOR

PATIENT SERVICES IN HEALTH CARE

By

Natalie Dick

May 2018

Dissertation supervised by Dr. Gerald Magill

Unanswered questions on how to allocate scarce resources in health care settings are often left to either bedside decision-making or, at best, the organizational policy level. Yet, there is little attention and no consensus on how organizational policy should address resource allocation in health care. An ethically sound framework is needed to guide policy development for resource allocation within health care organizations. In addition, a more comprehensive study of concepts tied to moral obligations of health care organizations is needed in terms of human rights, health disparities, and patient care quality. Until now, human rights literature has largely focused on obligations of governments and rarely addresses which obligations organizations may have to protect or promote the human right to health. This dissertation seeks to address the gaps in literature about the moral obligations of health care organizations to protect human rights and develop equitable resource allocation policies. The purpose of the dissertation is to establish an ethical framework for organizational resource allocation in health care.

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TABLE OF CONTENTS

Chapter 1: Introduction ............................................................................................................... 1

Chapter 2: Human Rights in Health Care ................................................................................ 50

2a A Right to Health Care .......................................................................................................... 50

2ai Health Care as a Human Right ........................................................................................ 50

The Emergence of Health as a Human Right ........................................................................ 50

Availability, Accessibility, Acceptability and Quality ........................................................... 54

2aii Equity in Health Care ...................................................................................................... 61

Horizontal Equity .................................................................................................................. 61

Vertical Equity ....................................................................................................................... 66

2b Human Vulnerability & Social Responsibility in Health Care ......................................... 70

2bi Respect for Human Vulnerability in Health Care ......................................................... 71

The Nature of Human Vulnerability ...................................................................................... 71

Special Vulnerability ............................................................................................................. 74

2bii Social Responsibility in Health Care .............................................................................. 80

Foundations of Social Responsibility .................................................................................... 81

The Social Dimension of Health Care ................................................................................... 85

Chapter 3: Patient Care Quality & Patient Safety .................................................................. 95

3a Patient Care Quality & Patient Safety as a Function of Human Rights........................... 95

3ai Defining Quality in Health Care ......................................................................................... 95

Patient Safety ......................................................................................................................... 96

Clinical Outcomes & Process .............................................................................................. 100

Patient Satisfaction .............................................................................................................. 105

Cost ...................................................................................................................................... 108

3aii Provision of Quality Health Care as a Human Right ................................................. 109

Human Right to Quality Care .............................................................................................. 110

Ethical Responsibilities of Health Care Organizations ...................................................... 113

3b Organizational Responsibility for Health Care Quality .................................................. 121

3bi Organizational Moral Agency ....................................................................................... 121

Organizational Identity and Moral Authority ..................................................................... 121

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Organizational Mission, Vision and Values ........................................................................ 126

3bii Organizational Obligations to Health Care Quality and Patient Safety .................. 129

Promoting Quality Care ...................................................................................................... 129

Protecting Patient Safety ..................................................................................................... 133

Chapter 4: Social Determinants of Health.............................................................................. 149

4a Social Determinants of Health & Cultural Competency .................................................. 149

4aii Ethical Challenges to Organizational Policy Stemming from Social Determinants of Health ...................................................................................................................................... 150

Diversity............................................................................................................................... 151

Barriers to Access ................................................................................................................ 157

4aii Developing Normative Ethics in a Multicultural Society through Human Rights Principles ................................................................................................................................ 160

Secular and Religious Bioethics .......................................................................................... 160

Human Rights ...................................................................................................................... 160

4aiii Organizational Policy focused on Cultural Competency to address Social Determinants of Health & Improve Quality ....................................................................... 165

Organizational Policy Focused on Cultural Competency ................................................... 165

Social Determinants of Health & Quality of Care .............................................................. 172

4b Social Determinants and Shared Decision-Making .......................................................... 180

4bi Applying Clinical Ethics within Health Care Organizations through Shared Decision-Making.................................................................................................................................... 180

What is Shared Decision-Making? ...................................................................................... 181

Informed Consent: The Roles of the Health Care Organization, the Physician, the Patient and the Surrogate ................................................................................................................ 182

4bii Addressing Social Determinants of Health through Organizational Policy focused on Shared Decision-Making ....................................................................................................... 190

Socioeconomic Status, Race, Ethnicity, Culture and Language.......................................... 193

Geographic Location and Access ........................................................................................ 195

Chapter 5: Medical Futility and Rationing ............................................................................ 204

5a Medical Futility .................................................................................................................... 204

5 ai Defining Medical Futility ............................................................................................... 205

The Role of the Patient or Surrogate ................................................................................... 207

The Role of the Health Care Provider ................................................................................. 209

aii Social Determinants of Health - Bias & Influence on Futility Assessments ............... 213

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Justice .................................................................................................................................. 214

The Role of Ethics Committees ............................................................................................ 217

5b Resource Allocation versus Rationing in Health Care ..................................................... 220

5bi Rationing .......................................................................................................................... 220

Justifications for Rationing in Health Care ........................................................................ 220

The Rationing Process ......................................................................................................... 223

5bii Ethical Resource Allocation .......................................................................................... 225

Goals and Tolerable Costs .................................................................................................. 225

Developing a Framework for Resource allocation ............................................................. 230

Chapter 6: Organizational Policy Framework for Resource Allocation ............................. 240

6a Resource allocation .............................................................................................................. 240

6 ai Assessing Fairness & Value ........................................................................................... 240

Fairness (Equity & Justice) ................................................................................................. 240

Value (Cost versus Benefit) ................................................................................................. 245

6aii Medical Futility and End-Of-Life Care ....................................................................... 248

Medical Intervention with Little or no Benefit .................................................................... 248

End of Life Care .................................................................................................................. 253

6b Resource Allocation Framework: Process, Methods, Assessment & Evaluation .......... 257

6bi Process & Methods ......................................................................................................... 257

Process for Resource allocation .......................................................................................... 257

Roles of the Provider, Patient and Ethics Committee ......................................................... 262

6bii Assessment & Evaluation .............................................................................................. 265

Assessing Resource Allocation ............................................................................................ 265

Evaluating Resource Allocation Organizational Policy ..................................................... 267

Chapter 7. Conclusion .............................................................................................................. 275

Appendix A ................................................................................................................................ 285

Appendix B ................................................................................................................................ 286

Bibliography .............................................................................................................................. 287

 

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Chapter 1: Introduction

A framework for resource allocation in the face of resource limitations is needed for

ethical health care organizational policy development, implementation and evaluation. The need

for this framework is supported by human rights principles, maximization of patient care quality,

and equitable treatment for all communities and individuals. The thesis of this dissertation is to

present an ethical framework for organizational resource allocation in health care to enable

organizations to develop sound policy when facing finite or constrained resources.

A population’s need for health services often exceeds the availability of critical

resources. When this occurs, health care organizations are compelled to allocate resources in

terms of which services they will provide and who they will to serve. The need for health care

resource allocation is increasingly prevalent in these settings, yet there has been a gap in

commonly accepted guidelines for making these decisions. Ethical debate on issues such as

rationing and medical futility have attempted to address this gap but un til now have posed

inadequate solutions. At the core of this problem lies the moral obligations of health care

organizations.

Unanswered questions on how to allocate scarce resources in health care settings are

often left to either bedside decision-making or, at best, the organizational policy level. Yet, there

is little attention and no consensus on how organizational policy should address resource

allocation in health care. An ethically sound framework is needed to guide policy development

for resource allocation within health care organizations.

In addition, a more comprehensive study of concepts tied to moral obligations of health

care organizations is needed in terms of human rights, health disparities, and patient care quality.

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Until now, human rights literature has largely focused on obligations of governments and rarely

addresses which obligations organizations may have to protect or promote the human right to

health. This dissertation seeks to address the gaps in literature about the moral obligations of

health care organizations to protect human rights and develop equitable resource allocation

policies. The purpose of the dissertation is to establish an ethical framework for organizational

resource allocation in health care.

The dissertation title is, “An Ethical Framework for Organizational Resource Allocation

for Patient Services in Health Care.” The purpose is to present an ethical framework to facilitate

ethical decisions by organizations about policy regarding health care resource allocation for

patient services. The ethical framework reflects the design of the chapters in the dissertation, as

follows. The ethical framework focuses upon pivotal components that organizations must

integrate when making ethical decisions about policy regarding resource allocation for patient

services. There are three pivotal components in the ethics framework: respect for human rights in

health care (chapter 2); the meaning of quality care for patients (chapter 3); and the social

determinants of health (chapter 4). These components constitute the ethical framework of the

dissertation in the sense that human rights in health care provides a foundation for integrating

individual and social perspectives as presented in the quality of patient care and in the social

determinants of health. In other words, the integration of these pivotal components (human

rights, patient care quality, social determinants of health) presents an ethics framework for

organizational decision-making about policy regarding resource allocation. To illustrate the

relevance of the ethics framework, it is applied to the complex topic of medical futility and

rationing (chapter 5) and then it is explained in a policy perspective to guide organizational

decision making (Chapter 6).

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Access to quality health care is a human right, based on principles of equity, respect for

human vulnerability and social responsibility. Unfortunately, inequalities in health care due to

race, ethnicity, culture, socioeconomic status, and access to health care can prevent individuals

from realizing this right. Health care organizations have a duty to address these inequalities via

their express moral agency, and begin to do so by facilitating cultural competency and promoting

shared decision-making.

Cultural competency and shared decision-making are important tools to promote health

equity and human rights but, especially within the context of finite healthcare resources, health

care organizations need additional and even more robust guidelines for addressing inequalities.

Presently, health care organizations lack a commonly accepted framework for assessing benefits

and allocating resources to protect equitable health care access. There is a need for a framework

focused on resource allocation within the confines of limited health care resources.

The framework for resource allocation should involve all stakeholders, including

physicians, patients and ethics committees where needed. Within this structure, the patient first

presents their values and goals, and the physician then provides an intervention’s intended

outcome, benefit and likelihood. The ethics committee or consultant works as a moderator when

there are communication barriers or value conflicts between the physician and patient.

Most importantly, in this resource allocation framework, the patient values and goals are

at the front and center of the decision-making process. This framework will help to achieve the

goals of equitable access healthcare, thus protecting the human right to equitable quality health

care.

CHAPTER TWO explains the foundations of health care as a human right based on

principles of equity, respect for human vulnerability and social responsibility. First, the right to

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healthcare is established and explained in terms of equity. Respect for human vulnerability and

social responsibility are then explained as the moral foundations for healthcare as a human right.

Human rights are based on the intrinsic dignity of human beings and should be afforded

to every person on the planet with no exceptions. Human rights encompass protections for all

human beings so that all persons can achieve self-determination. Health is a human right because

it is a prerequisite for any human to act freely and access to quality health care is a prerequisite

for health. Access to quality health care is therefore a prerequisite for humans to achieve the

right to self-determine and live freely.

Health and health care are requirements for participation in a democratic society since

they are requirements for functional ability. Realizing this right to health is influenced by many

factors. These factors include: insurance coverage, public versus private funding, the link

between social inequalities and health, access, health disparities, and resource allocation.1 To

operationalize a right to health, these issues need to be addressed through adequate and equitable

access to health care.

Health has emerged as a human right over the past century. Notable declarations on

human rights and health include the Universal Declaration of Human Rights, the International

Covenant on Economic, Social and Cultural Rights, and the Universal Declaration on Bioethics

and Human Rights. In 1948, the Universal Declaration of Human Rights outlined equal and

unalienable rights of all human beings founded in freedom, justice, peace, and inherent human

dignity, including a provision outlined in Article 25: “Everyone has the right to a standard of

living adequate for the health and well-being of himself and of his family, including food,

clothing, housing and medical care and necessary social services, and the right to security in the

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event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in

circumstances beyond his control.”2

Additional clarification on the right to health was established in the 1966 UN General

Assembly International Covenant on Economic, Social and Cultural Rights. This covenant

recognized that all humans have equal and unalienable rights, including rights to self-

determination, to be free from discrimination of any kind – including discrimination based on

gender and race, to work, to have safe work conditions, to have fair wages, to enjoy an adequate

standard of living – which includes freedom from hunger, to education, to take part in cultural

life, and to achieve the highest attainable standard of physical and mental health.3

Further, the 2005 UNESCO Universal Declaration on Bioethics and Human Rights

defined human rights as related to health and included principles of human dignity and human

rights, benefit and harm, autonomy and individual responsibility, consent, persons without the

capacity to consent, respect for human vulnerability and personal integrity, privacy and

confidentiality, equality, justice and equity, non-discrimination and non-stigmatization, respect

for cultural diversity and pluralism, solidarity and cooperation, social responsibility, sharing of

benefits, protecting future generations, and protection of the environment, the biosphere and

biodiversity.4 Although the foundation of the right to health has been laid, there is still a need for

these rights be clarified in terms of positive and negative obligations to availability, accessibility,

acceptability and quality of health care.

The meaningful realization to the right to health includes obligations to both the positive

right to health and a negative right to health. The positive right to health means that there is a

positive obligation to protect health access and informed decision-making, while the negative

right to health means that there is an obligation to avoid interference with health access and

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informed decision-making.5 These obligations should be explained with a consideration for real

costs and benefits, as well as a structure for resource allocation that is universal (rather than

culturally and economically relative.)6

The availability, accessibility, acceptability and quality of health care relies in large part

on health care financing. It must be noted that universal affordable health coverage has not been

achieved by private, for-profit providers or insurance in any North American country, so states

(and tax dollars) have become responsible for filling in the gaps to cover poor and seriously ill

through public programs.7 Health care organizations are thus constrained by the availability of

both the insurance market and government resources to provide equitable care for all individuals.

Health equity means empowering people, particularly socially disadvantaged groups, to

eliminate systematic health inequities and unfair differences that are socially produced, and is

essential to the right to health since health and agency have a mutually reinforcing relationship.8

This means that a person without agency is likely to have poor health outcomes, while poor

health diminishes a person’s agency. Health equity can be considered in terms of horizontal

equity and vertical equity. Horizontal equity explains that those with equal need should be

treated equally, while vertical equity explains that those with different needs should be treated

differently.9

Horizontal equity demands that individuals who are equal should be treated equally. An

appeal to horizontal equity must first define which individuals are determined to be equal and

thus should be treated equally.10 Individuals can have equal needs for different reasons. Multiple

dimensions of health care access, including geographic distribution of resources and financial

barriers to care, have been shown to influence health system horizontal equity in terms of health

service use.11

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The availability of health services is important determinant of health, so health care

resource allocation should be based on equitable and fair distribution.12 Specifically, health

equity could be promoted through improved access, support for primary care, enhanced health

information technology, payment model reform, national quality strategy, and monitoring of

disparities.13 To achieve horizontal equity, individuals with equal needs should have the ability

to meaningfully access an equal amount and type of health services and goods. To achieve

vertical equity, those with different needs should be able to access a different amount and type of

health services and goods.

Health equity is socially patterned and dependent on hierarchies of economic resources,

social resources, power and prestige.14 Different persons have different needs based on these

hierarchies and social patterns. Individuals and communities with greater needs should receive

greater health resources according to the concept of vertical equity. This can be further

conceptualized as empowering individuals and communities to make decisions and use health

services.15 This empowerment should be a policy objective at the national, state and

organizational level as measured by policy outcomes.16

Equitable access means that there should be no unjustified difference in the amount and

quality of health care one individual has over another. Social inequalities should particularly be

addressed to eliminate inequitable health outcomes, since social inequalities are closely related to

health inequality.17 Social inequalities contribute significantly to the manifestation of human

vulnerability and demand social responsibility from non-vulnerable members of the population

in accordance with human rights protections.

The principles of respect for human vulnerability and social responsibility are most

relevant to health and human rights and explain the organizational obligations to protect or

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promote the human right to health. Vulnerability is a common human experience, although the

degree of vulnerability that humans face varies greatly. Social responsibility describes the

obligations that humans have toward one another, especially toward other more vulnerable

humans. These two principles combined create the foundation for health as a human right. A

respect for human vulnerability is a foundational element of the right to health. All humans are

vulnerable in some capacity based on the mortal human condition, although some humans face

the extra burden of special vulnerability.

Human vulnerability is inextricable from health care since it is the very state in which

individuals need health care services. Respect for human vulnerability recognizes that all humans

will at some point(s) in their lives be vulnerable. Some human vulnerabilities are given greater

prominence in health care than others. This prominence given to specific vulnerabilities reflects

social views on which behaviors are personally controllable, which separates social perception of

sinners versus victims.18 Framing vulnerabilities within social contexts and structural inequalities

will help to clarify which behaviors are truly controllable and which are impossible or very

difficult to avoid based on a person’s social, political, or economic context.

There is a connection between all humans based on their common vulnerability, however

some humans face greater vulnerabilities than others and deserve special protection. Individuals

and groups with special vulnerability are at risk for poor health status and unmet healthcare

needs due to multifactorial and interacting risk factors, especially those related to inability to pay

for healthcare services – including low income, inadequate insurance coverage, and lack of

regular source of care.19 Vulnerabilities become compounded when a person is born into a

structural system of marginalization. The material and psychological stresses of social

inequalities and marginalization during periods of development can cause physiological changes

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that form the basis of a child’s ability to cope with future sources of vulnerability.20 The

disparities in access to health services between those with special vulnerability versus those who

do not are largely based on socioeconomic factors.

Based on the intrinsic dignity of human beings, there is an explicit social responsibility to

protect marginalized groups and individuals, meaning that health resources should be allocated

for the vulnerable.21 Furthermore, protection of vulnerable groups and individuals is good for

social systems and communities as a whole, not only for the vulnerable person under protection.

Lack of opportunity experienced by the vulnerable leads to degradation of the entire social

environment, meaning that attention to vulnerable groups contributes to general safety and

quality of life for the entire community.22 An indicator for overall social harmony and

community well-being is then the degree to which the vulnerable are cared for and protected.

Vulnerable persons or groups should have special protection since they have a greater

likelihood of being wronged due to inherited characteristics such inability to avoid exploitation,

susceptibility to harm, or lack of access.23 Vulnerable individuals are disadvantaged in their

ability to advocate for themselves, so society has an obligation to protect and advocate for them.

This means that individuals, groups and organizations within a society have a social

responsibility to those who are vulnerable.

Social responsibility in health care describes the moral responsibility to take care of those

who are vulnerable in a society based on the nature of humans as social beings. Health care

organizations have moral obligations rooted in social relationships that they participate in,

especially related to access to quality health care, access to adequate nutrition and water, living

conditions and the environment, marginalization and exclusion of any person or persons, and

poverty.24 Because a health care organization benefits from the vulnerabilities of individuals and

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groups within the social system that it is integrated with, it also has obligations to those who are

vulnerable.

In addition, health professionals engage in social contracts with patients, where they are

expected to put the interests the patient first, an expectation that is founded in justice when freely

agreed upon by all participating parties.25 The social relationship between the health care

professional and patient necessitate mutual responsibilities between both parties.

The social dimension of health care leads to social responsibility of hospitals and health

care delivery organizations, and is carried out by adequate corporate governance plus corporate

strategy where organizational values meet obligations to maximize available resources.26

Corporate social responsibility is especially important as a strong predictor of clinical

governance effectiveness, including high standards of care, transparent responsibility, and

accountability.27

CHAPTER THREE will discuss patient care quality as a function of human rights, and

describe the responsibility of health care organizations to protect health care quality and patient

safety. Patient care quality is a function of human rights. For humans to be able to meaningfully

exercise their human rights, they must be healthy and vice versa. This section will first define

quality in health care and then discuss how it is inextricably connected with human rights.

Quality in health care encompasses patient safety, clinical outcomes, clinical processes,

patient satisfaction and cost. Patient safety involves avoiding harm to patients as part of their

medical care. This includes avoiding medical error. Medical errors can cost billions of dollars in

annual cost to the US health system.28

Quality in health care encompasses the health outcomes and associated processes that

patients experience in the health care setting and is often measured in terms of outcomes and

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process measures. Process and outcomes measures each have strengths and weaknesses. Process

measures are direct, easy to interpret, and sensitive to differences in care quality, though they do

not reflect all aspects of care like outcomes measures, while outcomes measures include potential

inconsistencies with data collection and difficulty of proper risk adjustment are major

disadvantages.29 Efficiency is also a component of outcome and process methods. A method that

incorporates multiple, dynamic variables including resources, time periods, patient groups and

uncertainty of treatment paths could help to identify bottlenecks and improve hospital

efficiency.30

Both process and outcomes are important components of health care quality.

Process and outcome measures are often guided by governmental regulatory programs and payor

financial incentives. While regulatory policies and financial incentives can support health care

quality, they can also present barriers to quality if they are poorly designed. For example, poorly

aligned or fragmented financial incentives can impinge on the patient’s awareness of value or fail

to adequately address provider accountability.31 Likewise, governmental regulatory bodies can

fail to support health care quality if they are not well-designed. Thus, the health care

organization plays a crucial role in facilitating and ensuring quality patient care processes and

outcomes.

Patient satisfaction and patient-reported outcomes are also an important component of

health care quality. Patient-reported factors such as current behaviors, baseline health-related

quality of life, disease progression or regression, and treatment effects can help clinicians target

interventions to improve care quality.32 Patients can also report their satisfaction with health care

services to indicate the quality of care provided.

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Although there are many factors that can influence patient satisfaction, a comprehensive

approach that includes various service elements - such as multiple data sources to drive

improvement, accountability for service quality, service consultation and improvement tools,

service values and behavior, education and training, ongoing monitoring and control, and

recognition and reward - could be the most effective in improving patient perception of

excellence.33 This approach can also include attention physician communication, staff demeanor

and empathy, facility quality, nursing care, housekeeping, food, technical services, and access to

care.34 In addition, factors such as reputation of the physician, reputation of the healthcare

organization, health plan affiliation, and appointment availability are important to patients when

selecting a provider.35 Patient satisfaction, such as satisfaction with nursing and staff care, can

also influence a patient's willingness to recommend and willingness to return to a provider.36

Cost is also an important aspect of health care quality due to the finite nature of health

care resources. When costs are too high, access and availability of resources diminish. In

addition, allocating resources toward health care produces opportunity cost for other socially

beneficial services.37 In the United States, government (taxpayer) funding accounts for almost

two thirds of health expenditures, which includes spending on public employee health benefits,

tax subsidies to private health spending, and direct government payments to Medicare, Medicaid

and the Veterans Health Administration.38 This means that high health care costs can reduce or

eliminate resources for other public services that may benefit the well-being of the population.

In the era of cost-containment, health care organizational leadership have an imperative to take

medical management approaches with a goal of achieving the best outcomes for the lowest cost,

and eliminating inappropriate or unnecessary variation in care.39

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Health care costs can be influenced by many factors, but it should be noted no singular

reason can be blamed for high health care costs in the United States. Overutilization, for

example, has been named as an important reason for rising healthcare costs in the US, but should

not be overemphasized. High utilization of certain services, such as primary care, may actually

have a much higher benefit to cost ratio, even though high utilization of other specialty services

may yield low return on investment.40 Cost drivers are impacted by risk factors of patients like

age and case mix and while cost and quality are interconnected, the relationship between cost

and quality is not always the same.41

The cost of complying with the right to quality health care should also be mentioned

since it is related to the likelihood of an organization or government compliance with positive

rights to health. For example, the likelihood of a state complying with the Convention on the

Rights of a Child immunization protocol is dependent on capacity to meet associated

bureaucratic costs such as building a primary care delivery system, setting up and maintaining

appropriate incentives, and monitoring performance.42

Quality health care is a human right. In general, human rights discourse has involved a

growing awareness of rights related to health, including considerations for its associated complex

ethical and legal dimensions such as cultural relevance, regional indicators, individual versus

communitarian values, equality of access, and resource allocation.43 Though this discourse is an

important first step to integrating health and human rights, explaining health as a human right

lacks an important degree of precision. This discourse should instead be framed in terms of

quality health care as a human right, which both encompasses and more adequately defines

obligations to protect the right to health.

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Human rights can improve the effectiveness of quality care at the physician-patient level

when the physician incorporates the patient's will and interests into the interaction, thus

respecting the patient's individual dignity and rights.44 A human rights-based approach can also

help health care project leaders to pre-emptively address socioeconomic issues and potential

violations of rights, uncover design and implementation issues that impact access to

interventions, expand the breadth of outcome variables to measure success, and provide

opportunities for greater inclusion and project reach.45 Health and human rights-based claims of

justice can be used to support the protection and promotion of the functional capabilities required

for the exercise of positive freedom.46

The basic rights to health and health care traditionally have fallen into three domains: the

basic moral domain, the legally enforceable political domain, and the international domain (or

domain of relations between different political societies.)47 These three domains –

individual/moral, political/legal, and global – generally provide the existing framework for

human rights and health discourse. This framework lacks crucial domain in health and human

rights discourse, however: the organizational domain. The organizational domain exists as a

layer between the basic moral domain and the political domain, and is an essential missing piece

to this framework. The health care organization is the functional domain is where the right to

health is effectuated.

Health care organizations should facilitate quality through an ethics lens. Using ethical

standards as a foundation for developing quality improvement activities can help to prevent

inadvertently causing harm, wasting resources, or contributing to inequalities.48 Specifically,

quality in health care should be approached from a human rights perspective to ensure that health

care delivery is equitable, respect for human vulnerability is maintained and organizational social

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responsibility is realized. This can be accomplished by involving stakeholder dialogue and

empowerment of the poor, of communities, and of consumers when developing the relationship

between corporate operations and human rights.49

The essential responsibilities of health care organizational leadership include setting clear

direction, building the right leadership team, and creating the right culture.50 Organizational

leadership should also work with clinical teams in both the inpatient and outpatient settings to

ensure that there are resources and a structural foundation to support ethical decision-making.51

Leaders of health care organizations should also focus on organizational culture since culture can

influence how effective a health care organization is at achieving its goals.52

Organizations can incur cost related to ethical conflicts including both direct and indirect

costs associated with operations, legal issues, and marketing and public relations.53 This can

further exacerbate problems created by poor quality since fewer resources may infringe upon the

ability to make quality improvements. The organizational domain is where the right to quality

health care, and therefore the right to health are realized. Organizations can be held accountable

to moral obligations related to these rights based on principles of organizational moral agency.

Specifically, health care organizations have moral obligations to protect patient safety and ensure

quality of care.

An organization’s moral authority and identity, including its mission, vision, and values,

combine and result in an organization’s moral agency. Health care organizations have moral

agency based on their unique identity and moral authority. Organizational identity, including

organizational structure, represents the context in which a healthcare leader can accomplish the

mission of the organization.54 Corporate conscience is expressed as moral agency that manifests

in its mission-focused organizational traditions, policies, rules and leadership action.55 The

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operational effectiveness of achieving this mission can then be measured through indicators of

availability, quality and efficiency.56

Moral agency explains that a health care organization has a metaphysical personality and

existence distinct from its specific members, with rules of governance and hierarchical structure,

resulting in unique, distinct shared, intentions and coordinated behaviors, carried out by parties

who make decisions and carry out actions on behalf of the organization.57 The health care

organization is not a random amalgamation of the assets and individual persons who facilitate

and use its services, but a unique entity that is larger than the sum of these parts. This is reflected

in the unique expressed missions and values of health care organizations.

An organization’s mission statement is an expression of the unique moral identity of the

organization. An organization’s mission statement can improve its focus, such as increasing

attention on innovation or improving the balance between financial goals and the non-profit

mission.58 Likewise, expressed organizational values demonstrate the unique moral identity of

the organization. Organizational values in health care are important assets to innovation, growth,

ethical decision-making and quality, and can have a positive impact organizational success.59

Organizational values are the moral underpinnings of its decision-making – describing what

agents acting on behalf of the organization ought to do, and can motivate an organization’s

agents to arrive at intentional action based on the needs of collective.60 The organization has

agents which enact its mission and values. These agents are expected to act on behalf of the

organization, based on the organization’s unique identity.

Based on moral agency through expressed moral authority and organizational identity,

health care organizations have specific obligations to promote health care quality and protect

patient safety. Organizations have obligations to promote and protect quality health care and

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patient safety, based on their role in carrying out the human right to health. The organization

itself facilitates processes and outcomes of quality health care, based on organizational attributes

that influence quality such as executive management, culture, organizational design, incentive

structures, and information technology management.61 The organization itself is the driver of

quality health care, based on these traits. Health care organizational obligations include

protecting patients and staff members right to privacy, facilitating informed consent, facilitating

quality improvement activities, and reviewing potential safety risks to patients (such as

randomized designs, novel treatments, involvement of researchers, delayed feedback of

monitoring and external funding.)62

Organizations should also monitor quality outcomes to promote continuous quality

assurance and improvement. These quality measures should have a strong evidence base,

accurately reflect whether the intended process has been provided, be closely tied to the intended

improved outcome, and have little or no chance of creating unintended adverse consequences.63

Organizations should take a proactive approach to addressing potential ethical conflicts

related to patient safety, ideally collaborating with ethics committee members, clinical staff, and

providers to develop ethically grounded protocols, and establish systematic processes to ethical

practice and ultimately promote the goal of quality.64 This can be carried out by the health care

organization’s agents, including executive leadership. For example, executive leadership can

improve quality and safety by creating a culture of transparency, cooperativeness, inclusiveness,

and shared responsibility by focusing on communication, systems, teams, and accountability.65

The health care organization should use an integrated approach to addressing issues related to

quality in health care. The institute of medicine has advocated for systems approach, focusing on

interconnection of problems with the root cause analysis focusing on system flaws.66 Health care

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quality encompasses the interconnected components of the health care organization. These

components cannot be separated and need to be addressed as at the whole organization level to

adequately address health care quality. Quality health care is a human right carried out by health

care organizations.

CHAPTER FOUR describes the importance of social determinants of health related to

health care organizational policy. Social determinants of health – including race, ethnicity,

culture, socioeconomic status and barriers to access – have a serious impact on health outcomes.

Although addressing social determinants of health can be particularly challenging when facing

diversity in cultures, beliefs, and backgrounds, health care organizations can mitigate the

inequalities related to social determinants of health by focusing policy on cultural competency

and shared decision-making. Health equity can be achieved at least partially by reducing

disparities in health and securing access to highest possible quality of health care for all

individuals and groups.67

Social determinants of health include key components of race, ethnicity, culture,

socioeconomic status, and access to health care. Organizational policy founded in cultural

competency can help to alleviate some of the inequalities presented by these factors.

Social determinants of health present ethical challenges to organizational policy. The two

most salient challenges are diversity and barriers to access. A diverse population with varied

races, ethnic backgrounds and belief systems can lead to major challenges in health care.68 When

individuals in a society have varying backgrounds and belong to diverse social, religious and

cultural groups, it can be difficult to create a health care system that applies to all individuals

fairly. This is further complicated by (real or perceived) weaknesses of traditional bioethics

itself, which often faces criticism that it is based on western principles, methods, and philosophy

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and that it is lacking in its attempt to address the role of social and cultural values – specifically

those that define health, illness, pain, and death.69 If those analyzing ethical challenges to health

care hold a specific world view, they may not be able to seriously consider other legitimate

perspectives from other cultural groups. Barriers to accessing health care in a multicultural

setting include: Demographics – such as age, ethnicity, religion, and education level; Culture –

including worldview/perceptions in life, time orientation, and primary language; and Health care

system barriers – including access to care, financial resources, and poor doctor-patient

communication.70

Barriers to access can exacerbate health disparities and negatively impact quality of care.

Health care access barriers, including financial, structural and cognitive barriers, can result in

inadequate screening, late presentation to care, and lack of treatment resulting in poor health

outcomes and health disparities.71 Individuals and communities often face multiple barriers to

access simultaneously. For example, those with low health literacy are also more likely to be

uninsured.72

There are many interventions that organizations can engage in to improve health access

for the populations they serve. For example, health care access could be improved for low

income people by creating leadership coalitions, building shared information systems, seeking

catalyst funding, filling in gaps of service such as prescription drugs, creating care models that

achieve improved health outcomes, enlisting private physicians to volunteer for uninsured and

underinsured people, and achieving sustainable funding for care through state/local government,

business and community partnerships.73 In general, inequalities should be addressed through

interventions that make it an easy choice to engage in healthy behaviors.74 Removing barriers to

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access is an important first step to making healthy choices easy and moving toward equity in

health care.

In a multicultural society such as in the United States, there are varying approaches to

establishing ethical standards and boundaries for bioethics. These approaches can include secular

and religious bioethics. The approach which can be used as a normative ethic is based on human

rights. Secular and religious bioethics are offer competing theories of how to define “right” or

“good” in health care. Many secular philosophers believe that reason can deem certain behaviors

ethical or unethical through thought process, social negotiation, experience, sense or

perception.75 Religious theories are also common when approaching ethical theory in health care.

Religious theories tend to rely on revealed truth or natural theology. Revealed religious truth or

“faith knowledge” means that members of a particular religion have knowledge of true morality

that has been revealed to them through their religious doctrine.76 Natural theology is a theory of

religious ethics that states that there are natural ways of knowing moral norms, and that these

norms are revealed by reason.77 These varying and often conflicting theories offer a range of

approaches to health care ethics in multicultural societies.

Choosing one of these normative moral theories – secular or religious – may not be

possible because, in a multicultural society, individuals will have conflicting values,

backgrounds and cultural beliefs preventing them from agreeing on what is right and what is

wrong. Morally diverse individuals and groups can attempt to engage with each other through

bridging foundational differences, but should keep in mind that agreement about moral a

philosophy does not necessarily mean that it is justified, i.e. consensus can arise out of pressure

from power structures or mindless conformity rather than true moral justification.78 Using

methodologies of bridging theories and justifying actions can be helpful when navigating

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through differing moral beliefs within a multicultural society, however human rights should

always serve as the foundation for this discourse.

Human rights principles are principles that apply to everyone simply for the reason that

they are part of humankind. Human rights can and should be applied to health care ethics

because of its universal application and ability to create a guideline or framework for ethical

decision-making. The United Nations’ Universal Declaration on Human Rights provides

common standards for fundamental human rights to be universally protected, and includes

articles outlining these established rights.79 These rights include respect for human vulnerability

and justice, which should be applied in the multicultural health care setting.

Organizational policy focused on cultural competency can address social determinants of

health and thus improve quality and health equity. Human rights serve as a foundation for ethical

policy within health care organizations. In order to begin addressing the ethical challenges

presented by a multicultural society – including race, ethnicity, culture, socioeconomic status,

and barriers to access – health care organizations should develop a policy of cultural

competency. When founded in human rights, this organizational policy can impact social

determinants of health and ultimately improve quality of care. Cultural competence falls into

three buckets – organizational cultural competence, systematic cultural competence, and clinical

cultural competence, each with their own unique challenges such as problems with lack of

diversity in health care leadership and workforce, poorly designed systems for diverse patient

populations, and poor cross-cultural communication between providers and patients.80

Organizational policy can address each of these buckets. This policy can focus on interventions

such as evidence-based cost control, improving financial incentive structure, providing

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meaningful interpretation services, using community health workers, incorporating multi-

disciplinary teams, and improving patient education and patient empowerment.81

All levels of the health care system, including payers and regulatory bodies, should

emphasize cultural competence at a system level, striving to provide culturally and linguistically

appropriate health care services, which will ultimately impact access, utilization, and health

status of minorities.82 Health care organizations such as hospitals and health care systems should

work together with payers and regulatory bodies to create policy that provides the most benefit

for the patient population. Health care organizations can look to the National Standards for

Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS

Standards) for guidance on developing cultural competency policies. The CLAS standards

include provisions for governance, leadership, workforce, communication and language

assistance, engagement, continuous improvement and accountability – with the goals of

decreasing health disparities, enhancing health equity, and improving quality.83 These can be

used as a foundation for policy development and implementation within health care

organizations to foster culturally competent care.

Social determinants of health can have a significant impact on access to quality care and

quality outcomes. For example, Asian immigrants in the United States are less likely to have

health insurance or use health care services, and face barriers to quality health care including

linguistic discordance, health-related beliefs and cultural incompetency of health systems, issues

with accessing health services, and discrimination in the health care system.84 Multiple social

determinants of health can also intersect to affect quality outcomes. For example, age and race

can intersect to create disparities among those in the elderly population, with racial minorities

demonstrating worse health outcomes than whites of the same age group.85 Solutions to address

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this problem are multifactorial and include developing a diverse healthcare workforce that

reflects the diversity of the patient population.86

Health care organizations can also address health disparities caused by social

determinants of health by merging foundations of clinical and organizational ethics to develop

policy focused on shared decision-making. Clinical ethics can be applied through organizational

policy to mitigate social determinants of health through on shared decision-making between the

physician and the patient. Policy to support shared decision-making should focus on two key

features: ethics consultation and the informed consent process.

Shared decision-making can be used by health care providers and patients to determine

the best treatment option based on the patient’s values, beliefs and goals. The essential elements

of this process are: recognizing that decision needs to be made, understanding the evidence, and

incorporating patient values.87 Shared decision-making can improve care quality, improve patient

experience, and reduce costs – including the cost of surgeries and hospital admissions – through

low-cost interventions such as telephone health coaching.88 When patients have a chance to

consider the options along with their risks and benefits as they relate to their personal values,

beliefs and goals, they have the information that they need to make a truly informed decision.

Organizations can provide physicians with the education and tools to help patients participate in

shared decision-making. The organization should focus on policy related to informed consent

and ethics consultation to support shared decision-making and reduce barriers that physicians

and patients face when making decisions. This can be operationalized through policy focused on

informed consent and ethics consultation.

Informed consent is a crucial component of shared decision-making. Informed consent

encompasses legal rules, ethical doctrine, and an interpersonal processes based upon rights and

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duties, as well as consequences of actions, and is intended to protect bodily integrity and

autonomy.89 It is the mechanism in which patient autonomy and right to make decisions about

one’s own body and health are fulfilled. Legal or institutionally effective rules and requirements

of informed consent are intended to create conditions that enable autonomous authorization and

promote shared decision-making.90 The health care organization, the physician, the patient have

important roles in this process. Informed consent is based on decision-making capacity and it

should be assumed that a patient has decision-making capacity unless there is proof otherwise.91

When a patient does not have decision-making capacity, surrogate decision-makers should be

able to understand the patient's values and apply them to treatment decisions.92 Health care

organizations should develop policies and procedures to protect vulnerable patients without

surrogates that include the development of practical guides for clinical providers, increasing the

number of patients who complete a medical power of attorney document, and supporting

rigorous efforts to search for a surrogate decision-maker.93

Shared decision-making as supported by organizational policy can reduce health

disparities related to social determinates of health. Informed consent and ethics consultation can

support this process. Patients are influenced by risks and resources in their physical and social

environments often related to multiple dimensions of race, ethnicity and socioeconomic status,

which combine and accumulate to influence health outcomes.94 Socioeconomic status is one

dimension that significantly affects a patient’s ability to effectively interact with the health care

system. Patients with a disadvantaged socioeconomic status tend to have worse outcomes

compared to those in more advantaged situations. For example, long term breast cancer survival

outcomes could be improved by targeting patients with low socioeconomic status.95 Through

shared decision-making as carried out through the informed consent process and ethics

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consultation, the burdens of health disparities related to disadvantaged socioeconomic status can

be mitigated.

Race, ethnicity, culture and language can also have a significant impact on health

outcomes and shared decision-making. Although often intertwined with socioeconomic status,

race, ethnicity, culture and language present unique barriers to shared decision-making within the

health care setting. For example, a high socioeconomic position may not necessarily alleviate the

toxic effects of discrimination related to the psychosocial conditions and stresses tied to minority

status.96 These factors should be considered as presenting unique challenges to clinical ethics and

the shared decision-making process.

The location in which a patient lives can significantly affect their ability to access health

care and engage in shared decision-making. This can be especially true for individuals and

groups who live in rural areas. Barriers to receiving health services in rural areas can include

lack of knowledge of available resources, cost of services, difficulty navigating the system,

difficulty finding qualified providers, and proximity to services.97 These factors can all influence

a patient’s ability to engage in shared decision-making. A patient’s geographical location can

affect their access to health-related services as well. For example, a neighborhood food

environment can have a significant impact on health and accessibility to healthy food can be

affected by physical distance from food sources, personal mobility, and environmental barriers

such as safety concerns, and facilitators such availability of public transit service.98 These factors

influence health outcomes for groups and individuals in disadvantaged geographic areas,

including many rural areas. In addition, health care needs such as housing and transportation can

be affected by geographic location and availability of health resources. For example, adults with

multiple sclerosis, can face barriers to obtaining specialized housing, transportation, and

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resources needed to manage their progressive and episodic illness.99 Socioeconomic factors

could also act in concert with geographical barriers to health care from both individual and

neighborhood level factors.100 Informed consent and ethics consultation solutions could help to

alleviate some of these barriers to accessing health care and achieving quality health outcomes

through shared decision-making.

CHAPTER FIVE explores concepts of medical futility and rationing as foundations for

resource allocation. Health care resources are finite, yet demand for needed health resources are

virtually unlimited. This leads to the unfortunate reality that some people will be afforded access

to the health care resources they need, while others will not. Compounding this problem,

political discussions surrounding rationing, including claims of so-called “death panels,” have

hindered the ability of policy-makers to have meaningful discourse about fair dissemination of

limited health care resources. As a result, many of these resources have been distributed

sporadically with little or no ethical grounding.

Based on human rights that demand equitable, quality health care to all, health care

organizations have an obligation to develop more ethically sound ways of employing their

limited resources. These decisions should be founded in justice, and should not be influenced by

non-medically relevant patient characteristics such as race, ethnicity, culture, socioeconomic

status and geographical proximity to health care providers.

The basis for discourse surrounding resource allocation has heretofore focused on two

key concepts: medical futility and rationing. These two key concepts will be examined as

background concepts for resource allocation. Resource allocation will then be explained as a

concept which transcends the existing understandings of futility and rationing.

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Futile medical care can be thought of as a treatment or medical intervention where there

is no benefit, or where the amount of benefit achieved is judged as not worth its costs. When

unpacking this broad definition, however, flaws with applications for the medical futility concept

emerge. There is much ambiguity when exploring expected or possible outcome(s), and also how

likely those outcome(s) are to occur. This leads to the real possibility of drastic differences in

opinion among stakeholders regarding the futility of a particular patient in a particular situation.

Importantly, there has been no consensus on an acceptable threshold for probability that a

treatment will achieve a patient’s goals. This can lead to violations of equity when disagreements

in medical futility among stakeholders are influenced by bias, especially when these biases are

related to social determinants of health. Opinions of futility could be susceptible to opinions on

whether specific patients are worth of a perceived high-cost, low-benefit treatment. When these

judgements are made based on any non-medically relevant criteria, they unjustified and in

violation of the right to quality health care.

To make a determination of futility in a clinical setting, a patient’s goals should be

weighed against the probability of achieving those desired outcomes. If treatment intensity has

no relationship to survival, does not improve quality of life, does not improve suffering, does not

increase chances of a faster discharge, or help the clinical team and patient meet some other

specified goal, then the treatment in question should not be offered.101 The treatment in question

would be considered to be medically futile. Although seemingly straightforward, this definition

gains complexity and has contested relevance in application. Generally speaking, there is a lack

of consensus on the criteria for futility, with related available data inconclusive and susceptible

to subjective interpretation.102 This creates an environment where medical futility is understood

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as a vague concept, and specific guidelines for judging a case to be futile are difficult to establish

with unanimous agreement.

When it appears that a treatment may be deemed "medically futile," the provider and

patient (or surrogate) should discuss the options to determine the patient’s value system and

whether the treatment is appropriate or not for the patient.103 The role of the patient or surrogate

is to provide the values and goals of treatment option.

Futility reflects physician’s professional, not personal integrity, and goals of a futility

policy must have the ability to attract nearly universal agreement among health care providers, as

well as acknowledge political realities.104 No such universal agreement has yet been achieved.

The lack of consensus in definition among physicians themselves clouds understanding and

application of medical futility, and a clearer professional standard may be a key to provide clarity

for futility standards. As of yet, physicians nor politicians have been able to agree on

overarching, specific standards for judging medically futile interactions.

Physicians can personally avoid “futile” with patients, give patients and families time to

comprehend and express their understanding, clarify goals of care, assess whether all reasonable

options have been attempted, avoid offering options that are not medically appropriate, establish

guidelines and limits for interventions in place, and address emotional needs of patients – and

when they need support with these issues, physicians can have a patient care conference, review

steps with a colleague and/or request an ethics consult.105

Due to the problems that would come with mandating specific criteria to invoke medical

futility at the bedside, it may be more useful to apply medical futility as a foundation and

launching point for decision-making, helping to elucidate the limitations medical care.106 The

concept of medical futility could possibly help physicians develop acceptance that they are

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powerless in some clinical situations. The concept itself then may be useful, but only as a starting

point or foundation for a benefits assessment framework to emerge.

Social determinates of health can further complicate the ethical application of medical

futility concepts, especially if bias is introduced into medical futility discussions. Serious

injustice can occur when social determinants of health, such as race, ethnicity, education,

socioeconomic status, or geographic location negatively affect a patient’s care in medical futility

cases. The potential for grave, life-or-death consequences in medical futility cases means that

bias or unequitable treatment related to medical futility decisions opens the possibility for gross

injustice. When considering medical futility judgements, two patients with a similar condition

should be treated similarly and morally immaterial facts such as race or ethnicity should be

ignored.107 Biases due to social characteristics should be avoided in order to ensure equity under

the right to quality health care.

Ethics committees serve as a resource to health care institutions and address ethical

dimensions of clinical guideline development, policy advisement, and case review, and are

required as a part of the Joint Commission for accreditation.108 They are an essential part of

ethical decision-making within organizations. Ethics committees operationalize their ethical

support for decision-making through ethics consultation, which offer a structured method to

promote ethical decision making for professionals, patients, and families.109 Ethics committees

can mediate ethical questions when they arise during the shared decision-making process.

In all questioned medical futility cases, ethics consultants and ethics committees should

look to identify biases related to social determinants of health when facilitating medical futility

discussions. In their role on the ethics committee, ethics consultants should listen for and address

unspoken biases, while focusing discussion on clinically relevant information such as risks,

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whether the resource is scarce, complicated comorbidities such as addiction, concrete history of

non-compliance, long-term risks, psychosocial conditions, and whether the intervention will

prolong a painful dying process.110 Only medically relevant information should be included the

resolution of a medical futility conflict.

Although only medically relevant information should be considered when making a final

decision about futility, the process of determining the medical facts of the case should consider

social determinants as potential barriers to a just outcome. Ethics consultants can facilitate an

understanding of barriers that patients face to achieving a just outcome through cultural

competency and shared decision-making. Ethics committee consultations should also address

potential barriers patient shave to understanding important information related to costs and

benefits of care as compared to the patient’s goals. At times, patients make serious choices

without a full understanding of the proposed intervention. For example, Do Not Resuscitate

(DNR) patients may tend to have more concrete understanding of resuscitation, while full code

(FC) patients may tend to understand resuscitation in a more abstract sense.111 Patients should be

elevated to a place where they fully understand the benefits and costs of an intervention.

Finally, it must also be considered that biases may be entrenched within ethics committees

themselves, which organizations should attempt to avoid. Although ethics committees are used to

provide due process and a fair method for reaching resolution to a conflict, problems with this

role may occur when ethics committees do not represent the diversity of the population, have

financial ties to the hospital they serve under, or if they are reduced to a systematic process for

overriding family requests that seem unreasonable to the clinical team.112 Ethics committees

should then have mechanisms to avoid these biases, especially when dealing with cases of

medical futility. Health care ethics consultants should be able to help health are teams unpack

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biases, especially in the protection of vulnerable, marginalized, and disempowered patients and

families, helping to equalize the power dynamic in defense of justice.113 Ethics committees

should be facilitators of just decision-making, protecting patients with special vulnerability.

Medical futility arguments are often invoked in the context of the limited resources

available in health care, thus pulled into arguments related to rationing of health care. The idea is

that, if expensive but futile interventions could be avoided, costs to the system could be saved,

and resources spent in futility could provide benefit other patients. As long as the approach is

through a lens respect for human vulnerability and social responsibility, and the application is

filtered through ethically sound policies and processes, allocation of health care resources can be

a an ethically justified way to promote equitable access to quality health care.

While rationing relies on potentially unjust, inadaptable criteria for resource allocation,

resource allocation provides a framework that can adapt to specific patient situations and

characteristics (including social determinants of health), importantly including considerations for

quality of care, patient safety, cultural competence, and shared decision-making. With quality

care equitably maximized, human rights will be protected and health care delivery will become

more ethically grounded.

Due to the reality of limited health care resources, justification for systematic rationing of

health care has been attempted, albeit in ways that have been strongly contested. There is no

consensus on who should be entrusted to make rationing decisions, nor is there any consensus on

how rationing decisions should balance equity, efficiency and efficacy when facing a scarce

health care resource.114

Rationing is typically based on specific patient characteristics, or group characteristics of

patients that are in similar situations. Where demand for a therapy is beyond the resource

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capabilities of an organization (such as with transplantation), guidelines can be developed to

select and categorize patients for optimal use of those scarce resources with use of hierarchical

guidelines for patient selection.115 This type of rationing can only be justified when applied to

very specific situations in very specific contexts, while overarching judgements applied across

types of care are impossible to uniformly justify

Rationing discussions in the United States have focused primarily on insurance eligibility

and coverage but there is a need for more public debate on resource allocation related to financial

stability, trade-offs of cost containment versus achieving health goals, and how limited public

financing for healthcare should be.116 There is room for bias in rationing based on ability to pay

because public attitude can influence how much payers are willing to spend.117

Arguments for rationing have been made for various patient characteristics with

resistance. For example, age-based rationing has been argued as morally defensible in certain

situations, but has also been seen has ageist, discriminatory, and morally objectionable.118 Others

have argued that patient characteristics like productivity and lifestyle could be used for resource

allocation.119 Others have looked for common characteristics based on healthcare needs.

Previous use of resources for example, has been argued as a valid rationing criteria, with

justification based on protecting a basic level of benefits for all persons.120All of these criteria

have serious flaws in that there may be clearly justified exceptions to these rules, and when

exceptions to the rule are denigrations to the dignity of human lives, they should not be ignored

or discounted. In light of the controversy around rationing arguments, there has been some shift

from rationing language to language of waste avoidance, which are complimentary but not

synonymous terms.121 Waste avoidance gets more to the point of resource allocation, where

attempts are made to avoid using resources that do not add value.

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When rationing decisions are made, it is suggested that they committees should be used,

with public input and consideration of political realities.122 While this process may work for very

specific interventions such as transplant, developing rationing policies for a larger scope of

interventions can cause major problems and also, importantly, may face insurmountable political

barriers. In addition, contentious rationing decisions can be left to the court system, but this is far

from ideal. Allowing resource allocation decisions to be made through a court appeals process

could undermine fairness by granting greater access to wealthy people, reducing transparency,

compromising predictability and tainting the public’s perception of process fairness.123

Ethical resource allocation is based on a foundation of goals and tolerable costs and is

organized through a framework for organizational policy. Ethical resource allocation will be

explained in terms of goals and tolerable costs. Goals and tolerable costs, provide the foundation

for making decisions in health care’s resource-limited settings, including but not limited to cases

of medical futility.

When facing limited resources, resource allocation should be employed through a fair

and legitimate process, with resources pulled from ineffective or low benefit treatments to be

reinvested in more effective, higher-value care. 124 A framework is needed for assessing low

benefit care versus care with high benefit, considering tolerable costs and risks to patients based

on their personal values. Patients often need a focused and accessible explanation of risk

assessment including framing of the evidence, determining their own predisposition toward risk,

the likelihood of risk occurring, possible side-effects, what is involved in each potential course of

action, and which short term and long-term risks are important to them based on their values and

goals.125 An understanding of these risks and benefits in terms of the patient’s values will create

the foundation for resource allocation policy for health care organizations.

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The dimensions of equality that are normatively relevant need to be clearly defined since

implicitly unfair allocation will occur without the employment of explicit allocation criteria.126 A

transparent discussion is needed to determine how comparative effectiveness research can be

balanced between physician discretion, patient autonomy and system-level restrictions, with a

goal of using clinical data to inform decision-making within a flexible system responsive to the

complexity of health care.127 This resource allocation criteria can be mapped out into buckets of

feasibility, health level, health distribution, responsiveness, social and financial risk protection,

and improved efficiency.128 It will also include cost considerations since there is a need for clear,

explicit, transparent, inclusive process to determine how costs should be controlled, based on a

shared social understanding.129

A resource allocation framework will incorporate other related concepts, such as

accountability for reasonableness and evidence-based medicine, although existing concepts are

not comprehensive and must be supplemented with additional framework elements. For example,

evidence-based medicine seeks to generalize treatments, which may not be appropriate for all

individuals in an ethnoculturally diverse context such as in the United States.130 Evidence-based

medicine will work for resource allocation only within the ethical framework as described

henceforth.

CHAPTER SIX will focus on the specifics of the framework for resource allocation, and

how this framework will improve health care quality and promote human rights. This includes

addressing fairness in value assessments, the issue of medical futility, and the framework

process, methods, and evaluation mechanisms.

Resource allocation should focus on patient-directed goals, using cultural competence

and shared decision-making as tools to alleviate inequalities caused by social determinants of

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health. Focusing on assessment of patient goals and tolerable first and foremost will ensure that

treatments are aimed at the patient’s values and goals of care. The resource allocation framework

should be founded in fairness and value. This will be demonstrated through application to

medical futility end-of-life care debate.

Fairness, based on concepts of equity and justice, as well as value will be the basis for

resource allocation assessments. The resource allocation framework will be based in fairness and

equity both on both macro (organizational policy) and micro (bedside) levels. Fair bedside

rationing is needed in some cases, such as in triage (limited provider time, limited beds, limited

staff), in situations where resources are strained or subject to fixed limits (limited blood supply,

limited flu vaccines) and when the physician has an opinion that specific intervention will not be

worth the additional human or economic cost (assessment of individual benefit, assessment of

individual cost.)131 The resource allocation framework will incorporate the need for bedside

decision-making related to resource allocation.

Fairness is related to human rights as it is crucial for respecting the dignity of all persons.

If a person circumvents evidence-based, transparent, and unbiased resource allocation through

undue influence, they unjustly deny the dignity of the patient or patients who are consequentially

deprived of that same resource.132

The resource allocation framework will also be incorporate value, but only as long as it is

tightly connected with equity and justice. Value can be determined through various approaches,

but the recommended approach as part of this framework will be robust comparative

effectiveness analysis. An in-hospital comparative effectiveness center can be used to frame

existing literature within the local context, use local evidence where there are gaps in the

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literature, complement and strengthen national activities, adapt and implement measures locally,

and address the hospital’s own questions about quality, efficiency and effectiveness.133

The value of life is at the core of the medical futility debate. Medical futility cases are

often brought up at the end of life when interventions are prolonging life but not achieving many

or any other goals of care. Addressing medical futility is part of the resource allocation

framework because these are often the cases that provide the least benefit and some of the

highest (human and financial) costs. Often, there is conflict in medical futility cases due to

underlying, unrevealed beliefs and values that are not being addressed in the case. End-of-life

interventions can have broad, underlying social or ritualistic benefits to patients such as

addressing feelings of guilt and responsibility, reflecting upon the ambiguity between life and

death, providing a social script for letting go, and giving space to being the grieving process.134

The resource allocation model, facilitated by health care providers, staff, and ethics consultants,

can help to unearth some of these underlying issues to address the true reasons for conflict.

Medical futility should be addressed partially because of its implications for moral

distress on physicians and nurses. Repeated experiences of moral distress can have a negative

impact on quality patient care, burnout, job satisfaction, morale and can lead to exhaustion.135

Although, alternatively, moral distress could possibly reflect nursing discomfort with moral

subjectivity in some cases.136

The value of life is transcendental (which is the basis of its intrinsic dignity), finite (there

is an end to life for all living beings), priceless (one cannot put a monetary value on life), and it

is given (a person cannot create their own life).137 Since the value of life is priceless but finite,

the value of life does not depend on its length. Prolonging life is merely a benefit of treatment,

not a transcendent outcome above all others. Medical futility assessment during end-of-life care

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should examine all benefits of treatment, not just incremental length of life added. All human life

is priceless, regardless of social value, but life is not infinite. There is no moral obligation to

spend an infinite amount of money to save all life years and provide for a virtually unlimited

demand for health care, especially at high cost with marginal benefit.138 Only patients can define

the level of benefit and cost they experience from an intervention, so their values and goals need

to be at the center of this process. Truth telling is at the core of this process. Providing false hope

goes against the professional ethic of truth telling.139 In addition, family members can suffer

psychological effects and regrets following end-of-life decision making, and the clinical team

should help to prevent this distress to the extent possible, as long as it is not at odds with the

patient’s wishes and it does not cause suffering for the patient.140

The resource allocation framework includes process, methods, assessment and

evaluation. In this section, the process for resource allocation will be developed, including roles

of the physician, patient or surrogate, and ethics committee. The resource allocation process will

have two parallel tracks. First, will be the macro track for developing policy and procedures at

the organizational level and second will be the micro track where policies and procedures will be

carried out at the bedside. Each will be consistent with and in support of the goals of human

rights and equity. A human rights framework will ensure that resource allocation includes a

meaningful democratic deliberation with a prominent focus on equality and fairness.141

The macro track will be facilitated by the organization’s ethics committee, or a similar

committee with at least one trained bioethicist. This track will be responsible for the policy

decision-making process as consistent with the accountability for reasonableness framework.

Accountability for reasonableness has been applied with some success as an ethics-based,

procedural guidance for fair resource allocation through its four conditions of relevance,

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publicity, appeals and enforcement.142 Accountability for reasonableness is complementary to

human rights and clarifies some obligations based on human rights, with an emphasis on a

transparent process for resource allocation.143 It will help to guide a fair, transparent process

although it does lack normative fairness criteria for decision-making, which is important because

resource allocation should not only be legitimate in process but also fair in design.144A major

flaw with accountability for reasonableness is its assumption that reasonable equals fair.145 This

approach puts process over principles and avoids practical decision-making guidance for

distinguishing relevant versus irrelevant reasoning, lacking any theoretical underpinnings to the

concept of fairness.146 Although accountability for reasonableness will be incorporated into the

framework, it will not be the sole approach.

The macro track will also be responsible for consultation, developing and testing

decision-making, family support tools, and data analysis. Decision aid development for

vulnerable populations will focus on the eventual end users by assessing end user needs, pilot

testing with end user cohorts, and partnering with community-based organizations.147 This

committee will also facilitate and coordinate essential physician and staff training on cultural

competency, shared decision-making and nursing assessment for patient goals, values and risk

tolerance.

The micro track will be facilitated through shared decision-making and cultural

competency at the bedside. This process will involve either an electronic or nurse-facilitated pre-

appointment assessment of goals, values and risk tolerance. The physician will then discuss the

patient’s assessment and determine the best treatment option for the patient. Criteria will be

developed to trigger a consultation when risk is calculated to be greater than benefit for the

selected treatment. The patient will then participate in a consultation to ensure that the selected

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treatment is aligned with the patient’s goals and values. A decision-making framework should

include the following components: identification of the need for a decision, a process for making

the decision, and an action to be taken based on the decision.148 This will be incorporated into the

bedside decision-making process.

Decision support tools as developed by the ethics committee will be used as needed at the

bedside. Decision support tools should integrate clinical practice guidelines to both patient

decision aids and deliberation support tools.149 For example, an option grid may be developed

and used. The option grid includes frequently asked questions and answers to possible treatment

options, and is used through a process of describing the goal of the grid, checking if the patient

wishes to read the grid themselves or if they want them to be read to them, handing over the grid

to the patient with a pen so that they can mark down notes and questions, creating space if they

wish to read the grid themselves, asking encouraging questions and discussions, and telling the

patient that they should take the grid with them for the opportunity to discuss options with others

more information, encouraging referral to other specific sources.150 It is useful to implement an

iterative design process that engages the end-users when developing health care decision support

tools.151 Web-based decision-making aids could help facilitate discussions between patients and

clinicians, and help patients to make informed, individualized decisions152

The provider, patient and ethics committee will all have crucial roles in the resource

allocation framework. The physician-patient interaction should be based on shared decision-

making and mutual respect. Studies suggest that there is more discordance about decision-

making preferences than concordance between health care providers and patients, although the

degree to which this discordance occurs and the reasons for disagreement require further

study.153 Although more research is needed, there is some evidence to suggest that patient-

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centered care with interventions such as patient assessment, healthcare professional-patient

collaboration, acknowledgement of patient expertise in their own illness, education and patient

engagement, can help to reduce symptom burden, readmissions, and improve quality of life.154

Shared decision-making involves a respect for the patient perspective and strengthening the

patient-care team relationship.155 It is aligned with the goal of patient-centered care.

Patient-centered care maintains that patients should be involved in their own care and can

lead to both better outcomes and decreased cost, but it can be difficult to implement when there

are workload and workforce constraints, fragmentation of care and a destructive power dynamic

between the healthcare professional and patient.156 Patient-centeredness complements quality

measures and show the essential quality perspective of patient experience.157 Patient satisfaction

may be influenced by unrealistic expectations and poor perception of benefits and risk so

improved shared decision-making through decision aids with relevant personalized evidence-

based information can be a useful, ethically sound approach to treatment decision-making.158

Collaborative decision-making and patient-centered care may address the issue of health care

professional moral distress. Moral distress reflects health professionals’ frustration and failure to

meet moral obligations, and could be addressed by encouraging ethical action and allowing

questions to be raised and discussed.159 Often, this occurs when the health care professional must

weigh their professional obligation to the individual patient in front of them versus what is best

for the society as a whole.160 The resource allocation framework will alleviate this distress by

creating a clear structure for decision-making in these contexts. Staff will also be engaged to

empower them in the process. When the health care team is takes ownership of a process,

positive and necessary changes in culture can occur.161

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From the patient’s perspective, patient-centered care will help to address any social

disadvantages that may be negatively impacting their health, even if they seemingly should share

personal responsibility for their health outcomes. Appeals to personal responsibility can be

problematic if incentives create inequalities based on access or reciprocity-based responsibilities

don’t allow for flexibility in the amount an individual can reasonably be expected to

contribute.162

Ethics committees will also play an important role in the framework. Ethics committees

should be embedded into the broad framework and continuous process of organizational resource

allocation, approaching ethics consultation in four stages: training, identifying scarcity-related

problems, supporting decision-making and evaluation.163

The resource allocation framework will include a robust assessment and evaluation

component. The framework will include its background and philosophical foundations, the

process for engaging in resource allocation, and mechanisms for assessment and evaluation.

Physicians should first ask about the patient’s desired goals upon admission and present possible

treatments that have a reasonable chance of achieving those goals or, alternatively, set

expectations when goals are unachievable and present alternative options for the patient to

consider.164

The framework will encompass an organizational resource allocation policy with an end-

of-life decision-making subset. Resources will be tied to specific benefits. The process will

include defining the patient’s goals, determining the patient’s tolerable costs (such as quality of

life measures or complications,) and ensuring stakeholder understanding of patient goals and

values. When specific policy needs to be developed based on scarcity of resources, a general

assessment will be performed of the benefits of the intervention and which types of patients

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would benefit from the intervention. The process will be transparent with an appeals process. For

example, the problems associated with current approaches to Do Not Resuscitate (DNR) orders

could be addressed through better management of hospital culture, inclusion in policy

discussions, provider communication skill training, and better aligned financial incentives.165

In addition to the process for addressing general and specific resource resource

allocation, the framework will include a continuing education requirement for nurses and

physicians. Health care organizations should invest in quality communication programs to help

physicians navigate discussions around patient goals, navigating hope versus truth, making sense

of illness, refocusing on reality, encouraging patients to discuss their fears, navigating family

relationships and patient hesitations for “giving up,” as well as helping physicians to confront

their own struggle with impotence in times of futility.166 In addition, a common ethics course for

nurses and physicians could help them to develop an ethical skill set and instill in them a

confidence to exercise moral convictions, thus helping to avoid moral distress such as feelings of

powerlessness, guilt, sadness and anger.167

Finally, the ethics committee or consultant(s) will have an important role in the

framework. The ethics consultation can help to address conflicts experienced between families

and health care providers, including consideration of other’s perspectives, acknowledgement of

diversity, empathizing, and working together with involved parties to relinquish domination and

find a common ground.168

The framework will be evaluated for effectiveness. Successful resource allocation can be

evaluated based on process elements of stakeholder engagement, clarity of process, clear and

transparent information management, level of consideration for values and context, and revision

or appeals mechanism, as well as outcomes elements including stakeholder engagement, shifted

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resources, decision-making quality, stakeholder acceptance and satisfaction and positive

externalities.169Multi-dimensional outcomes will be considered knowing that a health care

service or intervention often has interdependent resources, such as in the case of cardiothoracic

surgery where both an operating room and bed for postoperative recovery are needed to admit a

new patient.170 The management of resources will be assessed. Management of healthcare

resources should incorporate the complex behavior of natural and social systems of health care

including multiple inputs and outputs, multiple perspectives and an environment of

uncertainty.171

CHAPTER SEVEN will conclude the analysis. An organization’s moral agency assigns

its ethical obligation to protect the human right to health care, based in the foundations of equity,

respect for human vulnerability and social responsibility. This obligation is particularly

important to reduce social inequalities within health care, based on social determinants of health

including race, ethnicity, culture, socioeconomic status, and access to health care. Health care

organizations can start to address these issues by using cultural competency and shared decision-

making, but these tools must be incorporated into a larger framework to promote health care

equity within the confines of finite resources.

A framework of resource allocation puts the patient’s goals and values first, with

recommended interventions presented in response. Resource allocation can also be used be in a

broader sense when distributing specific finite resources. Based on obligations of moral agency,

health care organizations are ethically obligated provide this framework, guiding the actions of

its agents and protecting the human rights of the patients it serves.

1 Gross, Aeyal. "Is There a Human Right to Private Health Care?" The Journal of Law, Medicine & Ethics 41, no. 1 (2013): 138‐146. 2 The United Nations. Universal Declaration of Human Rights. 1948.  3 UN General Assembly, International Covenant on Economic, Social and Cultural Rights. United Nations Treaty Series, vol. 993. 

1966. 

                                                            

Page 52: An Ethical Framework for Organizational Resource

 

44

                                                                                                                                                                                                4 United Nations Educational, Scientific, and Cultural Organization (UNESCO). Universal Declaration on Bioethics and Human 

Rights. 2005.  5 Lemmens, Trudo, and Candice Telfer. "Access to Information and the Right to Health: The Human Rights Case for Clinical Trials 

Transparency." American Journal of Law and Medicine 38, no. 1 (2014‐03‐06 2012): 63‐112. 6 Arras, John D., and Elizabeth M. Fenton. "Bioethics & Human Rights: Access to Health‐Related Goods." The Hastings Center 

Report 39, no. 5 (Sep/Oct 2009): 27‐38. 7 Kinney, Eleanor D. "Realization of the International Human Right to Health in an Economically Integrated North America." The 

Journal of Law, Medicine & Ethics 37, no. 4 (2009): 807‐818. 8 World Health Organization: Commission on Social Determinants of Health, 2005‐2008. A conceptual framework for action on 

the social determinants of health. 2007. 9 Tao, Yi, Kizito Henry, Qinpei Zou, and Xiaoni Zhong. "Methods for Measuring Horizontal Equity in Health Resource Allocation: A 

Comparative Study." Health Economics Review 4, no. 1 (Aug 2014): 1‐10. 10 Galbiati, Roberto, and Pietro Vertova. "Horizontal Equity." Economica 75, no. 298 (2008): 384‐91. 11 Gusmano, Michael K., Daniel Weisz, and Victor G. Rodwin. "Achieving Horizontal Equity: Must We Have a Single‐Payer Health 

System?". Journal of Health Politics, Policy & Law 34, no. 4 (2009): 617‐33. 12 Bayoumi, Ahmed M. "Equity and Health Services." Journal of Public Health Policy 30, no. 2 (2009): 176‐82. 13 Fiscella, K. "Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions." Annals of Family Medicine 9, no. 1 (2011): 

78‐84. 14 Marmot, Michael. "Achieving Health Equity: From Root Causes to Fair Outcomes." The Lancet 370, no. 9593 (Sep 29‐Oct 5, 

2007): 1153‐63. 15 Gulliford, Martin. "Modernizing Concepts of Access and Equity." [In English]. Health Economics, Policy and Law 4, no. 2 (Apr 

2009): 223‐30. 16 Erdman, Joanna N. "Human Rights in Health Equity: Cervical Cancer and Hpv Vaccines." American Journal of Law and 

Medicine 35, no. 2/3 (2009): 365‐87. 17 Potvin, Louise. "Promoting Health and Equity: A Theme That Is More Relevant Than Ever." Global Health Promotion 22, no. 1 

(2015): 3‐5. 18 Mechanic, D., and J. Tanner. "Vulnerable People, Groups, and Populations: Societal View." Health Affairs 26, no. 5 (2007): 

1220‐30. 19 Shi, Leiyu DrPH M. P. A. M. B. A., and Gregory D. PhD Stevens. "Vulnerability and Unmet Health Care Needs." Journal of 

General Internal Medicine 20, no. 2 (2005): 148‐54. 20 Furumoto‐Dawson, A., S. Gehlert, D. Sohmer, O. Olopade, and T. Sacks. "Early‐Life Conditions and Mechanisms of Population 

Health Vulnerabilities." Health Affairs 26, no. 5 (2007): 1238‐48. 21 Ruof, Mary C. "Vulnerability, Vulnerable Populations, and Policy." Kennedy Institute of Ethics Journal 14, no. 4 (2004): 411‐25. 22 Mechanic, David, and Jennifer Tanner. "Vulnerable People, Groups, and Populations: Societal View." Health Affairs 26, no. 5 

(2007): 1220‐30. 23 Tavaglione, N., A. K. Martin, N. Mezger, S. Durieux‐Paillard, A. Francois, Y. Jackson, and S. A. Hurst. "Fleshing out Vulnerability." 

Bioethics 29, no. 2 (2015): 98‐107. 24 International Bioethics Committee of UNESCO. On Social Responsibility and Health. 2010. 10‐39. 25 Welie, Jos V. "Social Contract Theory as a Foundation of the Social Responsibilities of Health Professionals." Medicine, Health 

Care, and Philosophy 15, no. 3 (2012): 347‐55. 26 Brandão, Cristina, Guilhermina Rego, Ivone Duarte, and Rui Nunes. "Social Responsibility: A New Paradigm of Hospital 

Governance? Health Care Analysis 21, no. 4 (2013): 390‐402. 27 Trong Tuan, Luu. "Clinical Governance, Corporate Social Responsibility, Health Service Quality, and Brand Equity." Clinical 

Governance 19, no. 3 (2014): 215‐234. 28 Van Den Bos, Jill, Karan Rustagi, Travis Gray, Michael Halford, Eva Ziemkiewicz, and Jonathan Shreve. "The $17.1 Billion 

Problem: The Annual Cost of Measurable Medical Errors." Health Affairs 30, no. 4 (2011): 596‐603. 29 Mant, Jonathan. "Process Versus Outcome Indicators in the Assessment of Quality of Health Care." International Journal for 

Quality in Health Care 13, no. 6 (2001): 475. 30 Hulshof, Peter J., Richard J. Boucherie, Erwin W. Hans, and Johann L. Hurink. "Tactical Resource Allocation and Elective 

Patient Admission Planning in Care Processes." Health Care Management Science 16, no. 2 (Jun 2013): 152‐66. 31 Nix, Kathryn A., and John S. O'Shea. "Improving Healthcare Quality in the United States: A New Approach." Southern Medical 

Journal 108, no. 6 (2015): 359‐63. 32 Fung, Constance H., and Ron D. Hays. "Prospects and Challenges in Using Patient‐Reported Outcomes in Clinical Practice." 

Quality of Life Research 17, no. 10 (Dec 2008): 1297‐302. 33 Kennedy, Denise M. M. B. A., Richard J. M. D. Caselli, Leonard L. PhD Berry, and Pooja Fache Mishra. "A Roadmap for 

Improving Healthcare Service Quality/Practitioner Application." Journal of Healthcare Management 56, no. 6 (Nov/Dec 2011): 385‐400; discussion 00‐2. 

Page 53: An Ethical Framework for Organizational Resource

 

45

                                                                                                                                                                                                34 Naidu, Aditi. "Factors Affecting Patient Satisfaction and Healthcare Quality." International Journal of Health Care Quality 

Assurance 22, no. 4 (2009): 366‐81. 35 Abraham, Jean PhD, Brian M. D. Sick, Joseph M. H. A. Anderson, Andrea M. H. A. Berg, Chad M. H. A. Dehmer, Amanda M. H. 

A. Tufano, and Kevin T. Fache Marx. "Selecting a Provider: What Factors Influence Patients' Decision Making?" Journal of Healthcare Management 56, no. 2 (Mar/Apr 2011): 99‐114; discussion 14‐5. 

36 Otani, Koichiro PhD, Brian Waterman, Kelly M. Faulkner, Sarah PhD Boslaugh, W. Claiborne M. D. Dunagan, and Sue PhD Ehinger. "How Patient Reactions to Hospital Care Attributes Affect the Evaluation of Overall Quality of Care, Willingness to Recommend, and Willingness to Return/Practitioner Application." Journal of Healthcare Management 55, no. 1 (Jan/Feb 2010): 25‐37; discussion 38. 

37 Gusmano, Michael K. "Do We Really Want to Control Health Care Spending?". Journal of Health Politics, Policy & Law 36, no. 3 (2011): 495‐500. 

38 Himmelstein, David U., and Steffie Woolhandler. "The Current and Projected Taxpayer Shares of Us Health Costs." American Journal of Public Health 106, no. 3 (2016): 449‐52. 

39 Lofgren, Richard, Michael Karpf, Jay Perman, and Courtney M Higdon. "The Us Health Care System Is in Crisis: Implications for Academic Medical Centers and Their Missions." Academic Medicine 81, no. 8 (2006): 713‐20. 

40 Levine, Deborah J., and Jessica Mulligan. "Overutilization, Overutilized." Journal of Health Politics, Policy & Law 40, no. 2 (2015): 421‐37. 

41 Kruse, Marie, and Jan Christensen. "Is Quality Costly? Patient and Hospital Cost Drivers in Vascular Surgery." Health Economics Review 3, no. 1 (Oct 2013): 1‐13. 

42 Gauri, Varun. "The Cost of Complying with Human Rights Treaties: The Convention on the Rights of the Child and Basic Immunization." The Review of International Organizations 6, no. 1 (Mar 2011): 33‐56. 

43 Bennett, Belinda. "Introduction: Health and Human Rights." International Journal of Law in Context 7, no. 3 (Sep 2011): 271‐72. 

44 Puras, Dainius. "Human Rights and the Practice of Medicine." (2017): Public Health Reviews 38. 45 Smith‐Estelle, Allison, Laura Ferguson, and Sofia Gruskin. "Applying Human Rights‐Based Approaches to Public Health: 

Lessons Learned from Maternal, Newborn and Child Health Programs." Etude de la Population Africaine 29, no. 1 (2015): 1713‐28. 

46 Ram‐tiktin, Efrat. "The Right to Health Care as a Right to Basic Human Functional Capabilities." Ethical Theory and Moral Practice 15, no. 3 (Jun 2012): 337‐51. 

47 Eleftheriadis, Pavlos. "A Right to Health Care." 268‐85: Wiley‐Blackwell, 2012. 48 Lynn, Joanne, Mary Ann Baily, Melissa Bottrell, Bruce Jennings, Robert J. Levine, Frank Davidoff, David Casarett, et al. "The 

Ethics of Using Quality Improvement Methods in Health Care." Review Article. Annals of Internal Medicine 146, no. 9 (2007): 666‐W161. 

49 Mena, Sébastien, Marieke de Leede, Dorothée Baumann, Nicky Black, Sara Lindeman, and Lindsay McShane. "Advancing the Business and Human Rights Agenda: Dialogue, Empowerment, and Constructive Engagement." Journal of Business Ethics 93, no. 1 (Apr 2010): 161‐88. 

50 Souba, W. W. "The 3 Essential Responsibilities: A Leadership Story." Arch Surg 145, no. 6 (Jun 2010): 540‐3. 51 Barina, Rachelle. "Ethics Outside of Inpatient Care: The Need for Alliances between Clinical and Organizational Ethics." HEC 

Forum 26, no. 4 (Dec 2014): 309‐23. 52 Khorakian, Alireza, Yaghoob Maharati, and Hanzaleh Zeydvand Lorestany. "Virtuousness and Effectiveness in Hospitals: The 

Moderating Role of Organizational Culture." Advances in Management and Applied Economics 6, no. 4 (2016): 45‐66. 53 Nelson, William A. PhD, William B. M. D. M. B. A. Weeks, Justin M. Campfield, and Les EdD Lfache MacLeod. "The 

Organizational Costs of Ethical Conflicts." Journal of Healthcare Management 53, no. 1 (Jan/Feb 2008): 41‐52; discussion 52‐3. 

54 Russo, Fabrizio. "What Is the Csr's Focus in Healthcare?" [In English]. Journal of Business Ethics 134, no. 2 (Mar 2016): 323‐34. 55 Fleming, David A. "The Moral Agency of Physician Organizations: Meeting Obligations to Advocate for Patients and the 

Public." Annals of Internal Medicine 163, no. 12 (2015): 918‐21 4p. 56 Gomes, Carlos F., Mahmoud M. Yasin, and Yousef Yasin. "Assessing Operational Effectiveness in Healthcare Organizations: A 

Systematic Approach." International Journal of Health Care Quality Assurance 23, no. 2 (2010): 127‐40. 57 Arnold, Denis G. "Corporate Moral Agency." Midwest Studies In Philosophy 30, no. 1 (2006): 279‐91. 58 Robert, E. McDonald. "An Investigation of Innovation in Nonprofit Organizations: The Role of Organizational Mission." 

Nonprofit & Voluntary Sector Quarterly 36, no. 2 (2007): 256‐81. 59 Helmig, Bernd, Vera Hinz, and Stefan Ingerfurth. "Valuing Organizational Values: Assessing the Uniqueness of Nonprofit 

Values." Voluntas: International Journal of Voluntary & Nonprofit Organizations 26, no. 6 (2015): 2554‐80. 60 Watson, George W., R. Edward Freeman, and Bobby Parmar. "Connected Moral Agency in Organizational Ethics." Journal of 

Business Ethics 81, no. 2 (2008): 323‐41. 

Page 54: An Ethical Framework for Organizational Resource

 

46

                                                                                                                                                                                                61 Glickman, Seth W., Kelvin A. Baggett, Christopher G. Krubert, Eric D. Peterson, and Kevin A. Schulman. "Promoting Quality: 

The Health‐Care Organization from a Management Perspective." International Journal for Quality in Health Care 19, no. 6 (2007): 341‐8. 

62 Baily, Mary Ann, Melissa Bottrell, Joannne Lynn, and Bruce Jennings. "A Hastings Center Special Report: The Ethics of Using Qi Methods to Improve Health Care Quality and Safety." The Hastings Center Report 36, no. 4 (2006): s1‐s40. 

63 Chassin, Mark R. M. D. M. P. P. M. P. H., Jerod M. PhD Loeb, Stephen P. PhD Schmaltz, and Robert M. M. D. Wachter. "Accountability Measures ‐‐ Using Measurement to Promote Quality Improvement." The New England Journal of Medicine 363, no. 7 (2010): 683‐8. 

64 Nelson, William A., Julia Neily, Peter Mills, and William B. Weeks. "Collaboration of Ethics and Patient Safety Programs: Opportunities to Promote Quality Care." HEC Forum 20, no. 1 (2008): 15‐27. 

65 Daly, Bobby, and Elizabeth A. Mort. "A Decade after to Err Is Human: What Should Health Care Leaders Be Doing?" Physician Executive 40, no. 3 (2014): 50‐2, 54. 

66 Khushf, George, James Raymond, and Charles Beaman. "The Institute of Medicine's Reports on Quality and Safety: Paradoxes and Tensions." HEC Forum 20, no. 1 (2008): 1‐14. 

67 Beal, Anne C. "High‐Quality Health Care: The Essential Route to Eliminating Disparities and Achieving Health Equity." Health Affairs 30, no. 10 (2011): 1868‐71. 

68 Charlesworth, M. "Don't Blame the 'Bio'‐‐Blame the 'Ethics': Varieties of (Bio)Ethics and the Challenge of Pluralism." J Bioeth Inq 2, no. 1 (2005): 10‐7.  

69 Mbugua, K. "Respect for Cultural Diversity and the Empirical Turn in Bioethics: A Plea for Caution." J Med Ethics Hist Med 5 (2012): 1.  

70 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 1.  

71 Carrillo, J. Emilio M. D. M. P. H., Victor A. M. P. A. Carrillo, Hector R. B. A. Perez, Debbie M. D. M. P. H. Facp Salas‐Lopez, Ana M. D. M. P. H. Natale‐Pereira, and Alex T. B. A. Byron. "Defining and Targeting Health Care Access Barriers." Journal of Health Care for the Poor and Underserved 22, no. 2 (May 2011): 562‐75. 

72 Sentell, Tetine. "Implications for Reform: Survey of California Adults Suggests Low Health Literacy Predicts Likelihood of Being Uninsured." [In English]. Health Affairs 31, no. 5 (May 2012): 1039‐48. 

73 Felland, Laurie E., Paul B. Ginsburg, and Gretchen M. Kishbauch. "Improving Health Care Access for Low‐Income People: Lessons from Ascension Health's Community Collaboratives." Health Affairs 30, no. 7 (Jul 2011): 290‐8. 

74 Wallace, Steven P. "Equity and Social Determinants of Health among Older Adults." Generations 38, no. 4 (2014): 6‐11. 75 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown 

University Press, 2012. 139‐148 76 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown 

University Press, 2012. 107‐129 77 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown 

University Press, 2012. 130‐136 78 Thompson, P. "Seeking Common Ground in a World of Ethical Pluralism: A Review Essay of Moral Acquaintances: 

Methodology in Bioethics by Kevin Wm. Wildes, S.J." HEC Forum 16, no. 2 (2004): 120‐128. 79 http://www.un.org/en/universal‐declaration‐human‐rights/ 80 Betancourt, Joseph R., Alexander R. Green, and J. Emilio Carrillo. "Cultural Competence in Health Care: Emerging Frameworks 

and Practical Approaches." The Commonwealth Fund, 2002.  81 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in 

Health Care. Washington: The National Academies Press, 2002:189‐198. 82 Chin, J. L. "Culturally Competent Health Care." Public Health Reports 115, no. 1 (2000): 25‐33. 83 https://www.thinkculturalhealth.hhs.gov/content/clas.asp 84 Clough, Juliana M. P. H., Sunmin ScD M. P. H. Lee, and David H. ScD M. A. Chae. "Barriers to Health Care among Asian 

Immigrants in the United States: A Traditional Review." Journal of Health Care for the Poor and Underserved 24, no. 1 (Feb 2013): 384‐403. 

85 Dilworth‐Anderson, Peggye, Geraldine Pierre, and Tandrea S. Hilliard. "Social Justice, Health Disparities, and Culture in the Care of the Elderly." Journal of Law, Medicine & Ethics 40, no. 1 (Spring2012 2012): 26‐32. 

86 Betancourt, Joseph R., Sarah Beiter, and Alden Landry. "Improving Quality, Achieving Equity, and Increasing Diversity in Healthcare: The Future Is Now." Journal of Best Practices in Health Professions Diversity: Education, Research & Policy 6, no. 1 (Spring 2013): 903‐17. 

87 Légaré, France, and Holly O. Witteman. "Shared Decision Making: Examining Key Elements and Barriers to Adoption into Routine Clinical Practice." Health Affairs 32, no. 2 (Feb 2013): 276‐84. 

88 Veroff, David, Amy Marr, and David E. Wennberg. "Enhanced Support for Shared Decision Making Reduced Costs of Care for Patients with Preference‐Sensitive Conditions." Health Affairs 32, no. 2 (Feb 2013): 285‐93.  

Page 55: An Ethical Framework for Organizational Resource

 

47

                                                                                                                                                                                                89 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  1‐13 90 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  15‐17 91 Mitchell, Melanie A. "Assessing Patient Decision‐Making Capacity: It's About the Thought Process." Journal of Emergency 

Nursing 41, no. 4 (Jul 2015): 307‐12. 92 Scheunemann, Leslie P., Robert M. Arnold, and Douglas B. White. "The Facilitated Values History: Helping Surrogates Make 

Authentic Decisions for Incapacitated Patients with Advanced Illness." American Journal of Respiratory and Critical Care Medicine 186, no. 6 (2012): 480‐6. 

93 Smith, Martin L., and Catherine L. Luck. "Desperately Seeking a Surrogate‐for a Patient Lacking Decision‐Making Capacity." Narrative Inquiry in Bioethics 4, no. 2 (Summer 2014): 161‐69. 

94 Williams, David R., Naomi Priest, and Norman B. Anderson. "Understanding Associations among Race, Socioeconomic Status, and Health: Patterns and Prospects." Health Psychology 35, no. 4 (2016): 407‐11 5p. 

95 Keegan, Theresa H. M., Allison W. Kurian, Kathleen Gali, Tao Li, Daphne Y. Lichtensztajn, Dawn L. Hershman, Laurel A. Habel, Bette J. Caan, and Scarlett L. Gomez. "Research and Practice. Racial/Ethnic and Socioeconomic Differences in Short‐Term Breast Cancer Survival among Women in an Integrated Health System." American Journal of Public Health 105, no. 5 (2015): 938‐46. 

96 Molina, Kristine, and Yenisleidy Simon. "Everyday Discrimination and Chronic Health Conditions among Latinos: The Moderating Role of Socioeconomic Position." Journal of Behavioral Medicine 37, no. 5 (2014): 868‐80 13p. 

97 Solovieva, Tatiana I., and Richard T. Walls. "Barriers to Traumatic Brain Injury Services and Supports in Rural Setting." Journal of Rehabilitation 80, no. 4 (2014): 10‐18 9p. 

98 Bader, Michael D. M., Marnie Purciel, Paulette Yousefzadeh, and Kathryn M. Neckerman. "Disparities in Neighborhood Food Environments: Implications of Measurement Strategies." Economic Geography 86, no. 4 (2010): 409‐30. 

99 Roessler, Richard T., Malachy Bishop, Phillip D. Rumrill, Kathleen Sheppard‐Jones, Brittany Waletich, Veronica Umeasiegbu, and Lisa Bishop. "Specialized Housing and Transportation Needs of Adults with Multiple Sclerosis." Work 45, no. 2 (2013): 223‐35. 

100 Beard, J. R., N. Tomaska, A. Earnest, R. Summerhayes, and G. Morgan. "Influence of Socioeconomic and Cultural Factors on Rural Health." Australian Journal of Rural Health 17, no. 1 (2009): 10‐15 6p. 

101 Courtwright, Andrew. "Who Is "Too Sick to Benefit"." The Hastings Center Report 42, no. 4 (Jul/Aug 2012): 41‐7. 102 Gabbay, Ezra, Jose Calvo‐broce, Klemens B. Meyer, Thomas A. Trikalinos, Joshua Cohen, and David M. Kent. "The Empirical 

Basis for Determinations of Medical Futility." Journal of General Internal Medicine 25, no. 10 (Oct 2010): 1083‐9. 103 Rubin, Susan B. "If We Think It's Futile, Can't We Just Say No?" [In English]. HEC Forum 19, no. 1 (Mar 2007): 45‐65. 104 Tomlinson, Thomas. "Futility Beyond Cpr: The Case of Dialysis." HEC Forum 19, no. 1 (Mar 2007): 33‐43. 105 Gallagher, Colleen M., and Ryan F. Holmes. "Handling Cases of 'Medical Futility'." HEC Forum 24, no. 2 (Jun 2012): 91‐8. 106 Tonelli, Mark R. "What Medical Futility Means to Clinicians." HEC Forum 19, no. 1 (Mar 2007): 83‐93. 107 Rosoff, Philip M. "Institutional Futility Policies Are Inherently Unfair." HEC Forum 25, no. 3 (Sep 2013): 191‐209. 108 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: 

Johns Hopkins University Press. 2015 (2nd edition). 5‐8 109 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: 

Johns Hopkins University Press. 2015 (2nd edition). 223‐227 110 Dudzinski, Denise M. "Commentary: In the Interest of Fairness." Cambridge Quarterly of Healthcare Ethics 22, no. 4 (Oct 

2013): 401‐2. 111 Downar, James, Tracy Luk, Robert W. Sibbald, Tatiana Santini, Joseph Mikhael, Hershl Berman, and Laura Hawryluck. "Why 

Do Patients Agree to a "Do Not Resuscitate" or "Full Code" Order? Perspectives of Medical Inpatients." Journal of General Internal Medicine 26, no. 6 (Jun 20111): 582‐7. 

112 Truog, Robert D. M. D. "Tackling Medical Futility in Texas." [In English]. The New England Journal of Medicine 357, no. 1 (Jul 2007): 1‐3. 

113 Stone, John R. "Commentary: Ethics and Medical Judgment: Whose Values? What Process?" Cambridge Quarterly of Healthcare Ethics 22, no. 4 (Oct 2013): 404‐6. 

114 Cohen, Alan B. "The Debate over Health Care Rationing: Déjà Vu All over Again?" Inquiry ‐ Excellus Health Plan 49, no. 2 (Summer 2012): 90‐100. 

115 Moosa, Mohammed Rafique, Jonathan David Maree, Maxwell T. Chirehwa, and Solomon R. Benatar. "Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle‐Income Country." PLoS One 11, no. 10 (Oct 2016). 

116 Teutsch, Steven M. D. M. P. H., and Bernd M. A. PhD Rechel. "Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint ‐ Us and Europe." Public Health Reviews 34, no. 1 (2012): 1‐10. 

117 Smith, Dylan M., Laura J. Damschroder, Scott Y. H. Kim, and Peter A. Ubel. "What's It Worth? Public Willingness to Pay to Avoid Mental Illnesses Compared with General Medical Illnesses." Psychiatric Services 63, no. 4 (Apr 2012): 319‐24. 

Page 56: An Ethical Framework for Organizational Resource

 

48

                                                                                                                                                                                                118 Fleck, Leonard M. "Just Caring: In Defense of Limited Age‐Based Healthcare Rationing." Cambridge Quarterly of Healthcare 

Ethics 19, no. 1 (Jan 2010): 27‐37. 119 Valtonen, Hannu. "Patient Characteristics and Fairness." The European Journal of Health Economics: HEPAC 10, no. 2 (May 

2009): 179‐86. 120 Huesch, Marco D. "One and Done? Equality of Opportunity and Repeated Access to Scarce, Indivisible Medical Resources." 

BMC Medical Ethics 13 (2012): 11. 121 Brody, Howard M. D. PhD. "From an Ethics of Rationing to an Ethics of Waste Avoidance." The New England Journal of 

Medicine 366, no. 21 May 2012): 1949‐51. 122 Callahan, Daniel. "Rationing: Theory, Politics, and Passions." The Hastings Center Report 41, no. 2 (Mar/Apr 2011): 23‐7. 123 Ladin, Keren PhD, and Douglas W. M. D. PhD Hanto. "Rationing Lung Transplants ‐‐ Procedural Fairness in Allocation and 

Appeals." The New England Journal of Medicine 369, no. 7 (2013): 599‐601. 124 Mitton, Craig, Francois Dionne, and Cam Donaldson. "Managing Healthcare Budgets in Times of Austerity: The Role of 

Program Budgeting and Marginal Analysis." Applied Health Economics and Health Policy 12, no. 2 (Apr 2014): 95‐102. 125 Price, Bob. "Discussing Risk with Patients." Nursing Standard (2014+) 31, no. 33 (2017): 53. 126 Rogowski, Wolf H., Scott D. Grosse, Jörg Schmidtke, and Georg Marckmann. "Criteria for Fairly Allocating Scarce Health‐Care 

Resources to Genetic Tests: Which Matter Most?" European Journal of Human Genetics : EJHG 22, no. 1 (Jan 2014): 25‐31. 127 Peppercorn, Jeffrey, S. Yousuf Zafar, Kevin Houck, Peter Ubel, and Neal J. Meropol. "Does Comparative Effectiveness 

Research Promote Rationing of Cancer Care?" Lancet Oncology 15, no. 3 (Mar 2014): e132‐8. 128 Tromp, Noor, and Rob Baltussen. "Mapping of Multiple Criteria for Priority Setting of Health Interventions: An Aid for 

Decision Makers." BMC Health Services Research 12 (2012): 454. 129 Fleck, Leonard M. "Choosing Wisely." Cambridge Quarterly of Healthcare Ethics 25, no. 3 (Jul 2016): 366‐76. 130 Whitley, Rob PhD, Cecile M. D. Rousseau, Elizabeth PhD Carpenter‐Song, and Laurence J. M. D. Frcpc Kirmayer. "Evidence‐

Based Medicine: Opportunities and Challenges in a Diverse Society." Canadian Journal of Psychiatry 56, no. 9 (Sep 2011): 514‐22. 

131 Hurst, Samia A., and Marion Danis. "A Framework for Rationing by Clinical Judgment." Kennedy Institute of Ethics Journal 17, no. 3 (Sep 2007): 247‐66. 

132 Shuman, Andrew G., Mary S. McCabe, Joseph J. Fins, and Paul T. Menzel. "It's Who You Know." The Hastings Center Report 42, no. 2 (Mar/Apr 2012): 12‐13,48. 

133 Umscheid, Craig A., Kendal Williams, and Patrick J. Brennan. "Hospital‐Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care." Journal of General Internal Medicine 25, no. 12 (Dec 2010): 1352‐5. 

134 Mohammed, Shan, and Elizabeth Peter. "Rituals, Death and the Moral Practice of Medical Futility." Nursing Ethics 16, no. 3 (May 2009): 292‐302. 

135 Özden, Dilek, Serife Karagözolu, and Gülay Yildirim. "Intensive Care Nurses' Perception of Futility: Job Satisfaction and Burnout Dimensions." Nursing Ethics 20, no. 4 (Jun 2013): 436‐47. 

136 Repenshek, Mark. "Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?" Nursing Ethics 16, no. 6 (Nov 2009): 734‐42. 

137 Sulmasy, Daniel P. "Speaking of the Value of Life." Kennedy Institute of Ethics Journal 21, no. 2 (Jun 2011): 181‐99. 138 Fleck, Leonard M. "The Costs of Caring: Who Pays? Who Profits? Who Panders?" The Hastings Center Report 36, no. 3 

(May/Jun 2006): 13‐7. 139 Thompson, Richard M. D. "Self‐Serving Altruism: Not an Oxymoron." Physician Executive 33, no. 6 (Nov/Dec 2007): 82‐3. 140 Truog, Robert D. M. D. "Is It Always Wrong to Perform Futile Cpr?" The New England Journal of Medicine 362, no. 6 (Feb 

2010): 477‐9. 141 Yamin, Alicia Ely, and Ole Frithjof Norheim. "Taking Equality Seriously: Applying Human Rights Frameworks to Priority Setting 

in Health." Human Rights Quarterly 36, no. 2 (May 2014): 296‐324,504‐05. 142 Byskov, Jens, Bruno Marchal, Stephen Maluka, Joseph M. Zulu, Salome A. Bukachi, Anna‐Karin Hurtig, Astrid Blystad, et al. 

"The Accountability for Reasonableness Approach to Guide Priority Setting in Health Systems within Limited Resources ‐ Findings from Action Research at District Level in Kenya, Tanzania, and Zambia." Research Policy and Systems 12 (2014): 49. 

143 Gruskin, Sofia J. D. M. I. A., and Norman PhD Daniels. "Justice and Human Rights: Priority Setting and Fair Deliberative Process." American Journal of Public Health 98, no. 9 (Sep): 1573‐7. 

144 Rid, A. "Justice and Procedure: How Does "Accountability for Reasonableness" Result in Fair Limit‐Setting Decisions?" Journal of Medical Ethics 35, no. 1 (Jan 2009): 12. 

145 Nunes, Rui, and Guilhermina Rego. "Priority Setting in Health Care: A Complementary Approach." Health Care Analysis : HCA 22, no. 3 (Sep 2014): 292‐303. 

146 Kieslich, Katharina, and Peter Littlejohns. "Does Accountability for Reasonableness Work? A Protocol for a Mixed Methods Study Using an Audit Tool to Evaluate the Decision‐Making of Clinical Commissioning Groups in England." BMJ Open 5, no. 7 (2015). 

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                                                                                                                                                                                                147 Dugas, Michele, Marie‐Eve Trottier, Dansokho Selma Chipenda, Vaisson Gratianne, Thierry Provencher, Heather Colquhoun, 

Joyce Dogba Maman, et al. "Involving Members of Vulnerable Populations in the Development of Patient Decision Aids: A Mixed Methods Sequential Explanatory Study." BMC Medical Informatics and Decision Making 17 (2017). 

148 Stafinski, Tania, Devidas Menon, Christopher McCabe, and Donald J. Philippon. "To Fund or Not to Fund PharmacoEconomics 29, no. 9 (Sep 2011): 771‐80. 

149 van der Weijden, Trudy, Antoine Boivin, Jako Burgers, Holger J. Schünemann, and Glyn Elwyn. "Clinical Practice Guidelines and Patient Decision Aids. An Inevitable Relationship." Journal of Clinical Epidemiology 65, no. 6 (Jun 2012): 584‐9. 

150 Seal, Robert P., Jeremy Kynaston, Glyn Elwyn, and Philip E. M. Smith. "Using an Option Grid in Shared Decision Making." Practical Neurology 14, no. 1 (Feb 2014): 54. 

151 Garvelink, Mirjam M., Julie Emond, Matthew Menear, Nathalie Briere, Adriana Freitas, Laura Boland, Maria Margarita Becerra Perez, et al. "Development of a Decision Guide to Support the Elderly in Decision Making About Location of Care: An Iterative, User‐Centered Design." Research Involvement and Engagement 2 (2016). 

152 Elkin, Elena B., Valerie H. Pocus, Alvin I. Mushlin, Tessa Cigler, Coral L. Atoria, and Margaret M. Polaneczky. "Facilitating Informed Decisions About Breast Cancer Screening: Development and Evaluation of a Web‐Based Decision Aid for Women in Their 40s." BMC Medical Informatics and Decision Making 17 (2017). 

153 Harrison, Mark, Katherine Milbers, Marie Hudson, and Nick Bansback. "Do Patients and Health Care Providers Have Discordant Preferences About Which Aspects of Treatments Matter Most? Evidence from a Systematic Review of Discrete Choice Experiments." BMJ Open 7, no. 5 (2017). 

154 Kane, P. M., F. E. Murtagh, K. Ryan, N. G. Mahon, B. McAdam, R. McQuillan, C. Ellis‐smith, et al. "The Gap between Policy and Practice: A Systematic Review of Patient‐Centered Care Interventions in Chronic Heart Failure." Heart Failure Reviews 20, no. 6 (Nov 2015): 673‐87. 

155 Bunn, Frances, Claire Goodman, Jill Manthorpe, Marie‐Anne Durand, Isabel Hodkinson, Greta Rait, Paul Millac, et al. "Supporting Shared Decision‐Making for Older People with Multiple Health and Social Care Needs: A Protocol for a Realist Synthesis to Inform Integrated Care Models." BMJ Open 7, no. 2 (2017). 

156 Gluyas, Heather. "Patient‐Centred Care: Improving Healthcare Outcomes." Nursing Standard (2014+) 30, no. 4 (2015): 50. 157 Anhang Price, Rebecca, Marc N. Elliott, Paul D. Cleary, Alan M. Zaslavsky, and Ron D. Hays. "Should Health Care Providers Be 

Accountable for Patients' Care Experiences?" Journal of General Internal Medicine 30, no. 2 (Feb 2015): 253‐56. 158 Jayadev, Chethan, Tanvir Khan, Angela Coulter, David J. Beard, and Andrew J. Price. "Patient Decision Aids in Knee 

Replacement Surgery." The Knee 19, no. 6 (Dec 2012): 746‐50. 159 Austin, Wendy. "Moral Distress and the Contemporary Plight of Health Professionals." [In English]. HEC Forum 24, no. 1 (Mar 

2012): 27‐38. 160 Antiel, Ryan M., Farr A. Curlin, Katherine M. James, and Jon C. Tilburt. "The Moral Psychology of Rationing among Physicians: 

The Role of Harm and Fairness Intuitions in Physician Objections to Cost‐Effectiveness and Cost‐Containment." Philosophy, Ethics and Humanities in Medicine : PEHM 8, no. 1 (2013): 8‐13. 

161 Greaves, Claire, Judy Gilmore, Lizelle Bernhardt, and Lisa Ross. "Reducing Imaging Waiting Times: Enhanced Roles and Service‐Redesign." International Journal of Health Care Quality Assurance 26, no. 3 (2013): 195‐202. 

162 Voigt, Kristin. "Appeals to Individual Responsibility for Health." Cambridge Quarterly of Healthcare Ethics 22, no. 2 (Apr 2013): 146‐58. 

163 Strech, Daniel M. D. PhD, Samia M. D. Hurst, and Marion M. D. Danis. "The Role of Ethics Committees and Ethics Consultation in Allocation Decisions: A 4‐Stage Process." [In English]. Medical Care 48, no. 9 (Sep 2010): 821. 

164 Davila, Fidel. "The Infinite Costs of Futile Care‐the Ultimate Physician Executive Challenge." Physician Executive 32, no. 1 (Jan/Feb 2006): 60‐3. 

165 Yuen, Jacqueline K., M. Carrington Reid, and Michael D. Fetters. "Hospital Do‐Not‐Resuscitate Orders: Why They Have Failed and How to Fix Them." [In English]. Journal of General Internal Medicine 26, no. 7 (Jul 2011): 791‐7. 

166 Srivastava, Ranjana. "The Art of Medicine: Critical Conversations: Navigating between Hope and Truth." The Lancet 378, no. 9798 (Oct 2011): 1213‐4. 

167 Ulrich, Connie M., Ann B. Hamric, and Christine Grady. "Moral Distress: A Growing Problem in the Health Professions?" The Hastings Center Report 40, no. 1 (Jan/Feb 2010): 20‐2. 

168 Illhardt, Franz‐Josef. "Conflict between a Patient's Family and the Medical Team." HEC Forum 19, no. 4 (Dec 2007): 381‐8. 169 Sibbald, Shannon L., Jennifer L. Gibson, Peter A. Singer, Ross Upshur, and Douglas K. Martin. "Evaluating Priority Setting 

Success in Healthcare: A Pilot Study." BMC Health Services Research 10 (2010): 131. 170 Bowers, John. "Balancing Operating Theatre and Bed Capacity in a Cardiothoracic Centre." [In English]. Health Care 

Management Science 16, no. 3 (Sep 2013): 236‐44. 171171 Baghbanian, Abdolvahab BSc MSc PhD, and Ghazal B. S. M. P. H. Torkfar. "Economics and Resourcing of Complex 

Healthcare Systems." Australian Health Review 36, no. 4 (2012): 394‐400. 

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Chapter 2: Human Rights in Health Care

2a A Right to Health Care

Human rights are based on the intrinsic dignity of human beings and require protections

for all persons to achieve self-determination. Health is a human right because it is a prerequisite

for any human to act freely and to make autonomous choices. Until now, the duties related to this

right have not yet been clearly defined, but this chapter will explain that the right to health

requires a right to quality health care. The right to quality health care is fundamentally supported

by principles of equity, respect for human vulnerability and social responsibility.

2ai Health Care as a Human Right

Health and health care are requirements for participation in a democratic society since

they are requirements for functional ability. Health was not always assumed to be a right,

however, and this right has evolved over the past several centuries.

The Emergence of Health as a Human Right

Human rights discourse emerged in the mid-1700s and showed its influence in the

American Declaration of Independence of 1776 and the French Declaration of the Rights of Man

and Citizen in 1789. It continued to develop after mass human rights violations during the two

world wars, and it grew into a global discourse through the establishment of the United Nations.

Bioethics has emerged alongside of human rights and is used to guide systematic health-related

human rights decisions and analysis.

Human rights discourse originated in both America and in France. In America, human

rights discourse first focused on both particularistic and universalistic version of rights language,

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while the French embraced the universalistic version.1 The American focus on universalism and

particularism was related to its core cultural value of independence. As Americans made

arguments for independence, human rights dialogue moved toward a universalistic approach,

although human rights became a secondary priority compared to concerns over the new national

framework. 2 While Americans saw human rights as secondary to its new national framework,

the French saw rights as a primary concern for its framework to rebuild its government. For these

reasons, The Declaration of Rights of Man and Citizen in France was established before The

Declaration of Independence in America. The Declaration of Rights of Man and Citizen laid out

general principles of justice including equality in the law, no arbitrary imprisonment or

punishments, and the accused as innocent until proven guilty.3 These became the foundations for

spreading acceptance of human rights principles.

The declarations of rights in America and France were both were formal, public

statements that claimed that rights already existed but needed to be defended.4 Although they

were a good start in defining human rights, these declarations proved to be thin and became

secondary considerations to other political and social issues of their time. It took two World

Wars and the creation of the United Nations to prioritize human rights and bring it to a global

forum. The emergence of the concept of “Right to Health” was an important part of this

dialogue.

Although the Universal Declaration of Human Rights recognizes that a person has a right

to adequate health and wellbeing, including medical care, its social impact on the right to health

has been minimal until recently. In the year 2000, the UN Committee on Economic, Social and

Cultural Rights issued General Comment 14, which clarified the scope, duties, and entitlements

related to the right to health.5 These rights include the right to the highest attainable standard of

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health, which was originally defined by the World Health Organization Constitution in 1948.6 In

addition, further clarification has been offered by a Right to Health Statement issued by the UN

High Commissioner for Human Rights and the United Nations Special Rapporteur on the Right

to the Highest Attainable of Health in 2005. This statement explains that the right to health

means clean water, sanitation, accountability in health care decisions, the abolition of user fees

for primary health care, and training of health care workers, and clarifies that the right to health

does not mean the right to be healthy or that a government is expected to fund expensive health

care technologies.7 Rights discourse continued on in clarification and specification.

The2005RighttoHealthStatementwasanattempttouniteidealisticgoalswitha

respecttopotentiallylimitedresources.Thisclarificationcouldbehelpfulforanynation,

butismostapplicableforhealth‐relatedrightsindevelopingcountries.Itdemonstratesa

pragmaticapproachforglobalhealthissues,lookingforsolutionsthatcanbeappliedtoall

nations,notonlythosewhichhavealotofresourcesorahighlevelofwealth.Thisis

importantbecauseglobalhealthisnotsomethingthatcanbeimprovedwithoutactionable

policy.Itmustaddressrealissuessuchashealthinequalitiesandhowresourcesare

distributed.8Whenmovingfromhigh‐leveldeclarationstospecificpolicyandadvocacy

issues,questionsarisesuchas:“Whoisresponsibleforhealthinequalities?”and“How

shouldresourcesbedistributed?”Theanswerstothesequestionsarenoteasysincethey

arebasedinvaluejudgments.Toanswertheincreasinglycomplexglobalhealthquestions

ofthemodernworld,amethodologythatfacilitatesasystematicethicalanalysisshouldbe

used.Globalbioethicsisthelinkthatcanfacilitatethisanalysisandhelpglobalhealth

advocatesmakedecisionsonspecifichealth‐relatedhumanrightsissues.

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The right to health forms the foundation of the right to quality health care, which

ultimately informs the responsibilities of organizations to address health inequity. The basis of

the right to health has been set forth by the United Nations. In December of 1948, the United

Nations established a standard of human rights for all persons through the Universal Declaration

of Human Rights. Notably, Article 25 of the Universal Declaration of Human Rights states that

“Everyone has the right to a standard of living adequate for the health and well-being of himself

and of his family, including food, clothing, housing and medical care and necessary social

services(…)”9 This article establishes a basis for discourse on health care as a human right.

In 2005, UNESCO (United Nations Educational, Scientific and Cultural Organization)

clarified the right to health by creating the Universal Declaration on Bioethics and Human

Rights, which describes key principles for recognizing and resolving ethical dilemmas in

bioethics.10 In 2015, the United Nations further clarified its approach to health and human rights

through the Sustainable Development Goals and Agenda 2030, which contains the goal of good

health and well-being.11 The goal of good health and well-being includes “universal health

coverage, including financial risk protection, access to quality essential health-care services and

access to safe, effective, quality and affordable essential medicines and vaccines for all.”12

The World Health Organization (WHO) adds additional clarity to the right to health.

According to the WHO, the right to health involves freedom to control one’s own body,

freedoms from interference in pursuing health and wellness, and equitable, systematic protection

for all to achieve the highest attainable level of health.13 This definition highlights the

importance of health equity, which has yet to be achieved in the United States. Health inequity

persists due to widespread disparities in access and outcomes based on social determinants of

health.

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The United Nations Sustainable Development Goals were adopted on September 25,

2015 and include the goal to “ensure healthy lives and promote well-being for all at all ages.”14

The sustainable development goals highlight the continuing global focus on the right to health.

Although human right discourse has not been met unchallenged, it continues to provide a moral

standing to demand change that protects the inherent human dignity of all humans.15 Human

rights, including the right to health, recognizes that humans are not simply a means but an ends,

and is based on the respect of humanity and dignity that is equal and inherent in all humans and

should be protected by laws and social arrangements.16 Health in particular should be protected

by civil society structure and its representatives is essential for the fulfillment of other human

rights and fundamental freedoms17

Availability, Accessibility, Acceptability and Quality

In August 2000, the United Nations Committee on Economic, Social and Cultural Rights

(CESCR) clarified preconditions for the right to the highest attainable standard of health as

availability, accessibility, acceptability and quality.18 These preconditions are also the

foundations for the right to quality health care.

The precondition of availability states requires that “Functioning public health and

health-care facilities, goods and services, as well as programs, have to be available in sufficient

quantity…”19 This means that there must be an adequate number of health delivery systems, as

well as an adequate number and amount of essential services provided by those systems. All

persons must have the right kind of and amount of health care services available to them in a

meaningful way.

Problems with health care availability persist across the United States due to inadequacies

of health resources to meet health care needs. This can cause a high level of strain on the US

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healthcare delivery system. For example, primary care availability affects the disproportionate

use of emergency and urgent care services in the United States. When primary health care is

unavailable due to long wait times, individuals are left with no other choice but to use urgent or

emergency care.20 This causes an inefficient use of and undue burden on already scarce

resources. In this case, primary health care is not effectively available for individuals to utilize.

When there are not enough health care resources to meet the needs of individuals in a

community, the criteria of health care availability is compromised.

Concerns of availability are not limited to direct medical care. Availability of community

pharmacies vary substantially across areas and are often misaligned with local population

needs.21 Availability concerns cross the continuum of health care into ancillary and secondary

health services which directly affect the realization of the right to health. In order to meet the

requirement of availability, all types of required services must be available to individuals who

need them. This includes general and primary care, inpatient hospital care, medical devices,

pharmaceutical drugs, and chronic condition management.

There are several specific contexts in which the precondition of availability is especially

challenging within the United Sates. The precondition of health service availability can be

particularly difficult in rural communities. There is an availability gap between rural and urban

medical care related to rural health shortage of physicians, hospitals, and associate health

professionals.22 Although this problem persists, health care delivery services can and should

work to address these availability gaps for rural populations. Namely, availability of health

services in rural communities can be improved through an integrated approach focused on

continuity of care, distribution of health workforce, capacity development through existing

networks, and collective action.23 A focused effort on improving these availability issues in rural

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areas can help to promote the right to health. Availability of health care services does not only

extend to physical resources, but also human resources. When there are not enough providers or

health care staff to meet the community needs, availability requirements are not met. Health care

delivery organizations have a clear role with related obligations within this integrated approach.

Health care delivery organizations can use a variety of approaches to address the

availability of health care services, thus meeting this precondition to health and human rights.

Technology is one example of how health delivery organizations can improve availability.

Technology can improve availability of care for specific and changing patient needs, such

coordination of primary and specialty care for those with multiple chronic conditions.24 One

example of this approach is the use of telemedicine. Telemedicine and other technologies could

be used to bridge the availability gap by allowing remote access to timely medical advice and

expertise.25 For example, rural hospital tele-ICU, is a tool that can be used for extra support and

assistance addressing availability problems of critical care workforce shortages, difficulty

recruiting and retaining, long distance between patients in hospital and home community26 In

addition, telemonitoring can be used to manage chronic conditions for vulnerable patients.

Telemonitoring can also be used to support chronic disease management, which will only

become more important as both the population life expectancy and chronic disease incidence

increase.27 These are just a few examples of how technology can address gaps in availability of

health services.

In addition to availability of services, individuals and groups must also have access to

available services to meet the conditions of health and human rights. Access includes the

meaningful ability to use available health care goods and services.

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The precondition of accessibility states that “health facilities, goods and services have to

be accessible to everyone without discrimination(…)”28 This means that all individuals must

have equitable access to health care delivery systems. In other words, all individuals who need a

health care service must have equal opportunity to use available health care goods and services.

Barriers to equitable access can include issues like lack of reliable transportation and inadequate

insurance coverage.

While a large amount of political discourse and public policy is focused on access in

terms of health care financing, reimbursement systems are not the only factor that infringe upon

equal access to health care.29 There are many reasons why individuals and groups may lack

access to the health services that they need. Timely access to health care may be affected by

factors like appropriate staffing, logistics of scheduling appointments, patient arrival times, and

providers keeping to schedules.30 Health care services may be available, but if they are not

available at a time when a patient can utilize the services, they will lack access.

Transportation and physical access can also be a barrier to realizing the right to health.

Older adults in rural areas face transportation barriers to access medical care as compared to their

urban counterparts.31 Those who do not live in areas with reliable public transportation may lack

transportation to health care facilities, other than emergency ambulance service. Also, those who

need ongoing non-emergency medical transportation, such as those with end stage renal disease,

can face barriers to access where frequency and timing of visits is an imperative for compliance

with treatments.32 Even if a service such as dialysis is available, if a person is unable to access

that necessary service, they will not be able to utilize it and ultimately lack the opportunity to

pursue their right to health. A person may also lack access to transportation for health-related

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goods and services such as healthy food and medication. Access to transportation can inhibit

one’s ability to achieve their highest possible level of health for many reasons.

In addition to resource barriers to access, socioeconomic barriers can limit or eliminate

meaningful access for some marginalized groups. For example, there is a variation of

neighborhood risk and access to care – especially in the southeast US where the legacy of racial

segregation prevails and there is a negative correlation between concentration of black residents

in individual’s neighborhood and satisfaction with health access.33 Another example of

socioeconomic access barriers is illustrated by the homeless population in the United States.

Barriers to access faced by the homeless go beyond health insurance to general mistrust of

healthcare providers, lack of access to primary care provider, and fear of legal ramifications.34

Barriers related to socioeconomic status that affect access to health care can be multifaceted and

complex. They can be physical or psychological, and very depending on a person or group’s

specific situation.

In addition to physical health care access, access to health services also includes access to

information. Access to information involves clear, direct communication that meets the needs of

those with low literacy level and low English proficiency, plus any other potential structural

barriers facing the patient population.35 An individual needs access to information for rational

decision-making about health care needs. If a person is not able to understand health-related

information due to language barriers, they will not be able to make informed decisions.

Likewise, if health information is not appropriate for the literacy level of the patient, they will

not be able to understand the critical information to inform their decision making. Health literacy

is also an important consideration. Health-related information should be provided in terms that a

person without a medical background or training can understand. Even if a person can read

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health information accurately, the format of the information is also important for health care

information access. If information is shared on a web-based platform, some patients may not be

able to access the information due to technology issues. A person may either not have access to

the required technology or not understand how to use the technology. The medium for sharing

information must be appropriate for a person to access essential health information.

Although technology presents some challenges, it can help with some access issues when

used appropriately. For example, an improved model of hybrid telephsyciatry could help elderly,

homebound adults connect with psychiatry services.36 Although there are technology solutions

for some barriers to access, other delivery and policy interventions must be initiated to address

the overarching issue of access. Interventions to improve health care access should include

focused community and neighborhood interventions.37 Interventions based on community and

group-based needs may begin to address some of the socioeconomic barriers to meaningful

healthcare access. Addressing these needs may also begin to facilitate acceptability and quality

preconditions of the right to health.

The preconditions of acceptability and quality state that all health facilities, goods and

services must be respectful of medical ethics and culturally appropriate (…)” and “health

facilities, goods and services must also be scientifically and medically appropriate and of good

quality.”38 Like availability and accessibility, responsibilities for these conditions also lie within

health delivery organizations. Health delivery organizations are those who carry out medical

interventions and are responsible for monitoring and ensuring acceptable and quality care

delivery.

In order to be acceptable and high-quality, health services must be responsive to

population and community-specific needs. Rational deliberation toward health incentives may be

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inhibited for those in the most disadvantaged environments, so smart design should be prioritized

over incentives and mandates.39 An acceptable and quality health system will use systems design

to provide health care delivery that meets the needs of the population it serves. Continuous

quality improvement will be an integral part of quality management, and current evidence-based

practices will be incorporated into quality design.

This systems design should use an integrated health care model. Health delivery models

should move away from specialized episodic models to integrated longitudinal model that

connects acute and community health systems with non-healthcare service systems.40 An

acceptable, quality health care delivery system will be integrated and meet patient needs across

the continuum of care. This integration will include important collaborations with communities

and other related health services across the continuum. Intersectional interventions are needed to

improve acceptability and quality of care that include attention to social, commercial, cultural,

economic, environmental, political determinants of health.41 A wholistic approach to health that

encompasses integrated care across the health care continuum will meet the criteria of

acceptability and quality.

Health care delivery systems have special responsibility to transform their organization to

meet these preconditions to the right to health. Health delivery leaders can transform

acceptability of health delivery by: building teams around shared vision; developing and

executing pillars of strategy at every level of the organization; commitment to teamwork;

fostering a high-reliability learning organization; alignment of people with a shared language;

Continuous and effective 360-degree communication and accountability; translation of big

picture goals in meaningful ways; transparency; tailored organizational structure; and translation

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of best practices.42 In these ways, health care delivery organizations can move toward the

establishment of preconditions for the right to health.

2aii Equity in Health Care  

The availability, accessibility, acceptability and quality of health care should be

established on a foundation of health equity. Equity means fairness, not necessarily equal

treatment – i.e. equality of opportunity versus equality of outcomes.43 The right to health

involves the right to fair and equitable health care that is available, accessible, acceptable, and

provides high-quality. The UNESCO Declaration on bioethics and human rights includes the

principle of equality, justice and equity that states: “The fundamental equality of all human

beings in dignity and rights is to be respected so that they are treated justly and equitably.”44 The

principles of human rights indicate that distribution of health care should be fair.45 A systematic

approach to health equity should be used to protect health and human rights. Without a

systematic approach founded in bioethics, non-equitable approaches may be used.

Specifically, human rights discourse should address disparities in health care outcomes

and help to define duties of health care organizations to provide quality care. These disparities

are related to both horizontal and vertical equity. Horizontal equity requires that those with equal

need be treated equally, while vertical equity requires that those with different needs be treated

differently, but fairly.

Horizontal Equity

Horizontal equity states that those with equal need should be treated equally.

Unfortunately, unfair health inequities exist in the United States, hindering the ability of

marginalized groups to realize the right to health. This is problematic in terms of disparities in

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health care availability, accessibility, acceptability, and quality. Health care is instrumental to

quality of opportunity since unfair disease and disability restricts normal opportunity and limits a

person’s fair, normal range of skills preventing them from accomplishing a life of flourishing.46

Individuals will not be able to meet fair opportunity to accomplish life goals without equitable

access to health care.

Inequalities in health outcomes can occur for various, often intersecting reasons. In

general, inequalities in flow from three major sources: the workings of social structure, voluntary

personal choices or behaviors, and natural differences in human endowment or fortuitous events

outside of social structure.47 In terms of health outcomes, inequalities can exist based on social

context, personal lifestyle choices related to health, and/or genetic fortune or misfortune. Social

context involves social vulnerabilities that may affect a person’s health. For example, vulnerable

groups experience a disproportionate burden of cancer incidence and mortality, at least partially

attributed to early experience that create downstream risk for cancer such as adverse childhood

experiences, maternal alcohol consumption in pregnancy, childhood obesity, high or low birth

weight, benzene exposure, exposure to tobacco in utero and early stages, and early exposure to

infection.48 Voluntary or personal choices may also affect incidence of cancer – for example

engaging in risky behaviors such as tobacco use. A person’s genetic predisposition to cancer may

also play a role. These risks and inequalities in health outcomes may grow from one or a

combination of these social, personal behavior, and natural differences in human biology. The

principle of vertical equity states that those who have equal need for health services – regardless

of the inequalities in risks that a person may face – should receive equal availability and access

to acceptable, quality care. The principle of vertical equity states that those who have equal

needs, should be treated equally.

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While those who have equal need for quality health care should receive equal availability

and access to quality health care, barriers often exist to prevent the realization of this right.

Addressing health inequities involves addressing the underlying reasons for unjust access,

availability, acceptability, and/or quality of health care. Health inequities occur across the social

gradient and are related to social and economic conditions where people grow, live, work and

age.49 A person’s environment and socioeconomic status can cause them to experience negative,

inequitable health outcomes. Health inequities are affected by economic inequities, disparities in

geographical dispersion of health services, and both direct and indirect costs of health care

access.50 The social inequalities that individuals face can create significant barriers to realizing

the right to quality health care. Based on horizontal equity, these social and economic reasons do

not justify denying a person’s right to quality care.

Some vulnerable groups face higher risk and worse health outcomes than others. The

inequity of health outcomes for those with the same health needs reflects horizontal inequities of

the health care delivery system. There are many examples of horizontal inequities in health care.

Over the last 30 years, breast cancer mortality rates have improved overall, yet many geographic

areas have actually seen a widening mortality gap in breast cancer outcomes between black and

white breast cancer patients.51 When advances in health care therapies and technologies are not

available for all persons equally, horizontal equity is unmet and the human right to health is

violated for those experiencing disparate care. Addressing disparities in health care outcomes is a

step toward improving horizontal equity in health care.

Horizontal equity is needed for the pursuit of health, or the realization of the right to

health. The principle of health equity creates an essential moral support for the justification of

quality health care as a human right. Human rights, including the right to health, protect the

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fundamental conditions or opportunity for pursuing a good life as well as the essential resources

needed to meet these conditions.52 The right to health is not meaningful if it does not require

resources or support for persons to realize that right. The right to health involves the right to

achieve the highest attainable level of health, and the support resources and services for all

persons to protect a person’s ability to pursue health. All persons should have equal opportunity

to pursue the highest achievable level of health, per the human right to health. Since many

individuals face inequitable conditions that prevent them from pursuing the highest quality of

health care available, this human right is not currently being realized either globally or within the

United States. State governments have a significant role in protecting equitable availability,

accessibility and acceptability of quality health care, but the responsibility for carrying out

conditions to protect this right lies within health care delivery organizations. Health care delivery

organizations have a responsibility to protect health equity at the level of health care delivery.

Health delivery organizations can use data to inform decision-making about horizontal

health equity. Data is an essential for effective implementation and monitoring of health equity

metrics. Disaggregated data should be used to illustrate patterns and indicators of health

distribution within the population and inform policies, programs, and practices related to health

promotion. 53 This data can inform health delivery organizations on how to provide equitable

services. Health care leaders can drill down on aggregated data to analyze any gaps in equitable

health outcomes and how these gaps may be improved or addressed.

Data related to health equity can frame horizontal equity and areas of improvement in a

productive way. Data analysts can find areas of opportunity where cooperation and capitalizing

on existing resources can reduce inefficiencies and unfair distributions to create more equitable

service delivery. In general, a paradigm of cooperation should be used since competitive, market-

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driven approaches create winners-versus-losers mentality which engenders health inequity.54

This approach, combined with data to inform decisions, will help health delivery organizations to

provide equal care to those with equal needs. Health care delivery organizations should

cooperate not only among themselves, but also with community stakeholders that have an

interest and can make an impact on key health issues. With data and information to inform

decisions, health care organizations can develop interventions to create more equitable

interventions and policies.

Importantly, the concept of cooperation rather than competition is aligned with, rather

than against American ideals of individual freedoms. In addition to ethical dimensions,

cooperation and fairness can create an improved economic environment. The free market can

benefit from distributional fairness in health because it can lead to higher consumption demand,

more productive members of society, and reduced crime through reduced poverty.55 Health

equity creates conditions where citizens can pursue the “American Dream,” – or the opportunity

to achieve regardless of social circumstance at birth. When distributional fairness exists and

individuals have fair economic opportunity, the concentration of wealth moves to the population

that will increase demand through consumption. In addition, those who are healthier and more

educated with more employment opportunities will be more productive members of society.

Poverty and crime rate also creates a positive social environment for the free market to thrive,

while simultaneously creating an improved quality of life for all citizens.

Health Delivery organizations can support horizontal equity in many established and

innovative ways. New approaches to health equity may help – including innovations in

technology. For example, social media can be used to facilitate knowledge translation and build

relationships to impact social determinants of health and equity.56 Health care delivery

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organizations have a responsibility to develop and apply approaches to protect horizontal equity,

and treat all individuals with equal need, equally. This includes health equity in all areas of the

triple aim of health care. The Triple Aim of health care reform – or improved outcomes, patient

experience and cost control - should be guided by a framework of health equity that promotes

institutional accountability.57 Health equity should include equitable opportunity for positive

health outcomes. It should also include equitable opportunity for positive patient experiences. In

addition, cost control and financial incentives should be implemented equitably among the

patient population. The triple aim will be most effective when health care delivery organizations

are accountable for monitoring and protecting horizontal health equity. Monitoring and data

analysis should include segmenting data to ensure that no marginalized groups have unfair, poor

outcomes compared to the general patient population.

Health delivery organizations have an obligation as well as the ability to protect

horizontal equity. Individuals with equal needs should be treated equally according to horizontal

equity. Also in accordance with equity, individuals with differing needs should be treated

differently but fairly. This is described as vertical equity. Health care delivery organizations also

have obligations to ensure vertical equity for the individuals and populations that they serve.

Vertical Equity

Vertical equity means that patients with differing needs should be treated differently, but

fairly. Patients may have differing needs for various reasons that may arise from existing

inequalities. For example, inequities in access and insurance status can result in patients

presenting in late stages of disease.58 When a person faces barriers to pursuing the highest

attainable degree of health, they have an elevated need for protection of the right to health.

Vertical equity explains that those who need more, should get more in terms of health services

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and protection of their right to health care. Those persons with special or extra needs related to

the pursuit of health can justifiably receive more resources or support to optimize their health,

based on vertical equity.

For example, those facing inequalities of access should be given preferential treatment

due to need, based on vertical equity. For example, if a specific neighborhood patient population

lacks transportation to the local hospital, a shuttle system may be instituted between the affected

neighborhood and the hospital. Since the specific neighborhood has a need, they will have

preferential treatment over other neighborhoods that do not lack transportation. Equity

considerations are important because, even though health is somewhat the product of voluntary

actions, it is more significantly affected by genetic, environmental and social factors that could

be avoided by medical and public health interventions.59 If medical and public health

interventions would be able to address the factors that inhibit one’s ability to pursue health, then

those medical and public health interventions should be implemented. Those who are unable to

access health care because they lack adequate social and economic resources such as education,

transportation, or health insurance, should be given a greater amount of assistance than those

who have adequate social and economic resources.

Many health outcomes are influenced by meaningful access to adequate, equitable health

care resources – including quality of life outcomes. For example, the quality of a person’s end of

life years are only weakly correlated with chronological age, while other aspects such as

behavior, genetic inheritance, social factors have a stronger correlation with end of life quality.60

These behavior, genetic, and social factors can be addressed through targeted interventions to

improve quality of life in those who suffer worse quality of life outcomes. Health delivery

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organizations protect fairness and equity by providing proportionate care to those who need it

more based on these factors.

Differing medical needs are not only based on social factors, but also on disease state.

For example, barriers to access of care for rare diseases include delayed diagnosis and limited or

nonexistent treatment options.61 Efforts to protect equitable treatment and access for those with

rare diseases would protect vertical equity. Patients who receive less attention or are not

effectively assessed because of their type of disease may face vertical inequity based on their

disease state. Likewise, if a person has an advanced stage of a particular disease, they can

legitimately receive more health resources and treatment options based on their medical need.

This is justifiable based on vertical equity.

In addition, the needs of changing population demographics will affect health care

delivery response to vertical equity. The population in the united states is getting older and more

diverse. Growing population diversity and increasing burden of chronic, interacting needs are

contributing to increasing complexity of patient needs.62 Those with greater needs based on these

demographic changes should be protected based on vertical equity. This will become

increasingly important as the population ages and becomes more diverse. Patients will have

highly variable health problems and present to health care delivery systems with differing levels

of health care needs. Health care delivery systems should provide different, but fair treatment to

those who present with varying degrees of health care needs.

Health care delivery systems can use various tools to address vertical inequity.

Disparities in health vary between communities and effective interventions have been employed

to improve health equity in some geographic areas. These successes can be used to create

solutions based successful interventions in terms of how to measure disparities and local

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variation, developing interventions from common elements of success, testing interventions, and

building coalitions and feedback loops.63 Community-based interventions that target individuals

and groups with greater risk and health needs can help to reduce vertical inequity of health.

Providing targeted, additional interventions and resources to those who need it the most is

aligned with vertical equity, which states that those with differing needs should be treated

differently, but fairly.

Communities lacking equitable health care availability, accessibility, acceptability and/or

quality should be included in the development of health delivery interventions to promote

vertical equity through multi-sector partnerships. Developing multi-sector partnerships that

include community stakeholders can help with identifying and addressing the inequitable social

structures and economic systems that contribute to health inequity.64 Health care delivery

systems can learn about the social, economic and environmental risks and community-specific

needs through these partnerships. When there are specific socioeconomic or community needs,

the key stakeholders can offer not only root causes but also propose solutions that could be

meaningful to their community.

For example, some communities have a high incidence of obesity, and have a greater

health needs due to obesity-related health problems. Health care delivery organizations can tap

into existing resources and create new, community-specific interventions to address health

problems in vulnerable groups, like those with high incidence of obesity. The CDC has a toolkit

to address disparities in obesity incidence, addressing the role of environmental factors and the

persistence of health disparities related to age, income, education, gender, race, ethnicity, and

geographic region.65 This is just one example of a tool that health delivery organizations can use

to target, monitor and address community or group-specific health needs and promote vertical

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equity. Health care delivery organizations can work with communities to use both existing tools

and to develop innovative ways to affect their barriers to health.

Promoting health equity is essential for protecting health and human rights. Human rights

protect the fundamental conditions of pursuing a good life, or conditions necessary for engaging

in basic activities like deep personal relationships, active and passive pleasures, and attaining

knowledge.66 When a person does not have a fair chance to pursue a good life, they are not being

afforded human rights. Health equity is a critical component of the right to health. In addition,

the health equity and the right to health are prerequisites to all other human rights, since a person

must be healthy before they can pursue any other opportunity.

The obligations of health care delivery organizations to protect horizontal equity are

related to the nature of human vulnerability. Obligations related to vertical equity are related to

special vulnerability. Social responsibility in health care explains why these obligations exist to

protect these vulnerabilities, thus promoting health equity.

2b Human Vulnerability & Social Responsibility in Health Care

Respect for human vulnerability and social responsibility are the most relevant principles

for health and human rights and explain the organizational obligations to protect or promote the

human right to health. Vulnerability is a common human experience, although the degree of

vulnerability that humans face varies greatly. Social responsibility describes the obligations that

humans have toward one another, especially toward other more vulnerable humans. These two

principles combined create the foundation for health as a human right.

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2bi Respect for Human Vulnerability in Health Care

The UNESCO Universal Declaration on Bioethics and Human Rights includes the

principle of respect for human vulnerability and personal integrity, declaring: “In applying and

advancing scientific knowledge, medical practice and associated technologies, human

vulnerability should be taken into account. Individuals and groups of special vulnerability should

be protected and the personal integrity of such individuals respected.”67 This means that the

concept of vulnerability must be integrated into assessments of health and human rights. The

respect for human vulnerability is linked to respect for personal integrity.

Rights and interests of the vulnerable should be protected, although criteria on how to

protect the vulnerable needs more robust and integrated guidelines.68 Criteria and guidelines for

protecting vulnerability will be described in this dissertation.

There are two major views of human vulnerability that will be discussed in this chapter:

the universal view of vulnerability as the fragile, ontological condition of humanity and

relational vulnerability, which affects those who have diminished capacity to protect their own

interests.69 The nature of human vulnerability will be discussed first. The nature of human

vulnerability describes how all humans are fragile and share a mortal condition. Special

vulnerability describes how some humans experience an elevated level of vulnerability based on

specific and special conditions or circumstances.

The Nature of Human Vulnerability

The nature of human vulnerability describes the common human condition of

vulnerability. All humans have a common vulnerability based on the shared potential to be

wounded physically psychologically, morally, and spiritually and the shared ability to suffer.70

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All humans have this common capacity to be harmed, and thus vulnerability is part of human

nature and common to all humans.

All humans share a degree of vulnerability based on the mortal human condition and

capacity for suffering. All humans are vulnerable at some point in their life continuum.

Vulnerability, which can occur at any time in individual's life, is dependent upon internal and

external factors within the lifecycle continuum, is linked to risk and susceptibility, and involves

an interplay between environment and individual.71 Humans have the capacity to become

vulnerable due to both internal and external factors. Internal factors include human biology and

susceptibility to physical and mental suffering and disease. External factors can also cause

vulnerability, such as a person’s economic resources, and how well they are able to respond to

environmental stressors. Both internal and external factors will interact to create vulnerabilities

during a person’s life.

For example, if a person is having financial troubles and at the same time is diagnosed

with cancer, these two vulnerabilities work together to create the person’s overall vulnerable

situation. The nature of human vulnerability describes how all humans are susceptible to this

type of suffering. All humans may, at any time in their life, financially struggle while at the same

time receive a diagnosis of cancer. Some individuals may be more or less susceptible, but all

individuals have some level of susceptibility to this suffering. The financial/cancer diagnosis

example is just one example of a way in which any human has the potential to suffer but there

are infinite examples of this common potentiality for suffering. Therefore, the human condition

includes a common potential for suffering, or vulnerability. Both individual and environmental

factors will affect the manifestation of a person’s vulnerability. How the nature of human

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vulnerability manifests in each person may differ related to the individual and environmental

factors that a person faces, but the potential for this suffering is equal in all humans.

The nature of human vulnerability is the foundation for the justification for health equity

and health and human rights. All humans are vulnerable, so all humans have a level of equal

need for protection of their human integrity. The complex and subtle realities of a patient’s

disease experience can inhibit their ability to self-manage, so vulnerability and dependency

should be included as guiding principles for both health policy discourse and clinical practice.72

There is a potential in all persons to lose the ability to self-manage and become dependent based

on the realization of their common human vulnerability. Health policy and clinical practice

should recognize that all humans have this potentiality and principles of horizontal equity should

be incorporated into policy and practice to protect this common vulnerability.

Protecting the right to health and equitable availability, accessibility, acceptability and

quality of care will ensure health equity – specifically horizontal health equity – and elevate the

capacity for and recognition of humanity in all persons. Human vulnerability bonds and binds

people, tending to the intense social needs of humans by allowing for the possibility for

compassion to suffering and connection with the common humanity of mortality and fragility.73

The nature of human vulnerability, and the protection of health equity through the right to quality

health care facilitates the recognition of common humanity and dignity, and creates a higher

level of understanding and respect for what it means to be human.

The nature and importance of human vulnerability creates an obligation to protect those

in whom this vulnerability has manifested. The nature of human vulnerability explains that all

humans have the potential to be harmed, or to suffer, and reciprocity would entail an obligation

to protect others with the understanding that oneself would be protected when in need. Since all

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humans are vulnerable or susceptible to physical and emotional injury, attack, wound or damage,

all humans need a level of protection or prevention of harm or violation of personal integrity.74

Providing this protection helps others within human societies, but also is protection for oneself

knowing that the nature of human vulnerability means that oneself could experience injury,

attack, wound or damage at any time.

All are vulnerable but some are more vulnerable because of membership in group such as

those who are poor, marginalized groups, disadvantage, people of color, low socioeconomic

status.75 Those who face vulnerability in addition to the nature of human vulnerability, have

special vulnerability that must be protected under the principle of vertical equity. The universal

vulnerability of the human condition allows for circumstances that lead to special vulnerability,

such as those related to disease, disability, personal conditions, environmental conditions, and

limited resources.76 The nature of human vulnerability is the precondition for special

vulnerability. The nature of human vulnerability should be protected in respect to horizontal

equity, while special vulnerability should be protected with respect to vertical equity.

Special Vulnerability

The Council for International Organizations of Medical Sciences (CIOMS) Guidelines as

revised in 2002, have defined vulnerability as: "a substantial incapacity to protect one's own

interests owing to such impediments as lack of capability to give informed consent, lack of

alternative means of obtaining medical care or other expensive necessities, or being a junior or

subordinate member of a hierarchical group;” and outlined special protections afforded to

vulnerable groups: “accordingly, special provision must be made for the protection of the rights

and welfare of vulnerable persons.”77 A person who is unable to protect their own interests and

needs special protection has special vulnerability. A person may not be able to protect their own

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interests based on inability to give informed consent or because of power dynamics that keep

them from making free and autonomous decisions. Individuals who experience special

vulnerability and are unable to advocate for themselves and their own interests deserve special

protection in terms of the human right to health.

Health care delivery organizations have the power and the obligation to protect and

address the sources of these special vulnerabilities. Special vulnerability is a harmed condition

that leads to limited opportunities leading to deprivation of worthwhile experiences, missed

possibilities and missed opportunities.78 In these terms, vulnerability has a clear negative impact

on the realization of the human right to health. Special vulnerability impacts the degree and

manner that individuals are able to pursue opportunities for health and well-being. Special

vulnerability is the realized potential of the nature of human vulnerability. It can be caused by

risks associated with group membership, or group vulnerability.

The European Court of Human Rights has characterized group vulnerability, which has

allowed it to substantively address aspects of inequality. Although this characterization risks

stigmatizing, essentializing, stereotyping, it can be useful (when aligned with the work of

international and human rights organizations) for prioritization of scarce resources, guiding state

preference to those who need the most.79 Based on special vulnerability, some individuals have a

claim to more resources than others, and many individuals with these claims are part of

marginalized groups that make them especially vulnerable. Identifying groups with special

vulnerability can be an efficient ay to allocate resources to groups with a history of

marginalization. This cannot be the only approach, however, since the risk of overgeneralizing

may miss vulnerable individuals and groups that do not fit into the explicit group categorization

of need.

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Special vulnerabilities hinder the ability of individuals to pursue opportunities and reach

potential for well-being. In other words, obstacles that restrict capacity for flourishing create

special vulnerability.80 The goal of vertical equity is to remove these obstacles for flourishing.

The human right to health offers protection for vertical equity in health and the ability for all

humans to have equal opportunity to flourish. The opportunity to flourish entails the opportunity

for self-actualization and reaching one’s potential.

Geographic, demographic and socioeconomic characteristics can impact the special

vulnerability of individuals and groups. When studying special vulnerability, it is helpful to

examine these characteristics to determine the root cause special vulnerability. Neighborhood

risk factors can give insight to chronic diseases, which can disproportionately burden minorities

and low-income populations.81 There are many factors that can lead to special vulnerability

caused by the environment and social context of individuals and groups.

Special vulnerability can be caused by a multitude of reasons and special vulnerabilities

can have a compounding effect. Individuals and groups may face double disparity when they are

both medically overburdened and medically underserved, facing a disproportionate number of

environmental hazards plus limited health care access.82 These environmental factors can include

individual and group risk factors. The environmental and medical risks faced by an individual

can create a high level of special vulnerability that may impact the realization of the right to

health if vertical equity concerns are not addressed. Analyzing and addressing these vertical

equity concerns should incorporate community feedback and involvement in policy decision-

making. Vulnerable populations, such as African Americans, should be given fair, proportional

representation in policy decision-making decisions that affect them.83 Involving vulnerable

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populations in decisions that affect individuals in their communities can help to provide the

appropriate services and care and promote vertical equity.

In addition to environmental and socioeconomic vulnerabilities, life course can cause

special vulnerabilities. Age-related vulnerability is heightened at both the early and late years of

life, and the lowest age-related vulnerability somewhere in between.84 Special vulnerability is

explained as conditions of one’s life – either internal or external - that lead to diminished ability

to realize opportunities and rights. Those who have diminished abilities based on age-related

restrictions face special vulnerability. This includes the elderly and young children. Age-related

vulnerability tends be highest at the beginning and end of life, with the lowest level of age-

related vulnerability in the middle of a person’s life cycle.

Life course also influences a person’s vulnerability through early development that

affects coping mechanisms later in life. The life-course perspective explains that health later in

life is shaped by earlier experiences or previous stages of life course, so systematic economic and

social factors can create vulnerability or resilience at end of life.85 This can accumulate over

one’s lifetime and over generations. Those who have faced harmful conditions early in life, may

face greater vulnerability later in life due to their early exposure. Likewise, those who have faced

health-reinforcing experiences early in life may face a higher level of resilience later in life. The

differences in vulnerability caused by the life-course perspective can create vertical inequities, or

greater needs in those who have had harmful health-related experiences earlier in their life.

Special vulnerability should also be considered in terms of health care research. Special

vulnerability is related to health care research in terms of barriers to sampling, recruitment,

participation and retention of socioeconomically disadvantaged as research participants.86

National and international laws and guidelines have been established to protect these

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vulnerabilities. The Belmont Report, signed into law in 1974, explains vulnerability in terms of

human research subjects and includes special protections for vulnerable groups such as racial

minorities, the economically disadvantaged, the very sick, and the institutionalized.87 In addition,

international guidelines have been established to protect special vulnerability in research. In

1964, the World Medical Association Declaration of Helinski created guidelines to protect

vulnerable individuals participating in research involving human subjects.88 The Declaration of

Helinski was last updated in 2013, and the current version includes clarification on special

groups with vulnerabilities: “Some groups and individuals are particularly vulnerable and may

have an increased likelihood of being wronged or of incurring additional harm.”89 Although there

are risks to conducting research with vulnerable groups and individuals, it should still be

completed in respect to protecting health equity. Research should look at how healthcare

resources can be distributed to alleviate injustice for vulnerable populations.90

Health care delivery organizations have an obligation to address special vulnerabilities

and protect vertical health equity. Special vulnerability is related to structures, institutions, and

processes that cause and exacerbate health inequalities that hinder vulnerable groups’ equal

claim to goods and services needed to live dignified flourishing life.91 Organizations can

accomplish this by developing a paradigm shift should occur when facing vulnerable individuals

and populations from protection of, to protection against.92 This shift re-focuses responsibilities

from specific vulnerable individuals and groups toward conditions that create vulnerabilities.

Addressing special vulnerabilities in health care delivery organizations involves accurate

and reliable assessment of vulnerable patients. Although assessment of psychosomatic

characteristics of vulnerability are generally straightforward, assessment of functional and social

domains of vulnerability demonstrate a high level of variability among physicians and may

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benefit from a consistent vulnerability assessment instrument to promote a uniform and accurate

assessment of vulnerability.93 Physicians do not reliably assess functional and social domains of

vulnerability, so these areas should be consciously integrated into vulnerability assessments at

the health care delivery level. Special vulnerability can be complex and multidimensional,

including psychosomatic, functional and social elements.

In addition, health care delivery systems should implement programs to monitor and

address special vulnerability and vertical equity at the system level. Health care delivery systems

should use data to monitor and analyze potential inequities in health within their system. Health

information systems can support special protection of vulnerable groups by tracking health

inequalities, creating systems of accountability, and strengthening the empirical base for human

rights analysis and decision-making.94 Health care delivery organizations can use this data to

focus interventions that address these vulnerabilities. Data analytics can provide information on

if and where inequalities may exist. It can also create accountability for those who are tasked

with improving inequalities or protecting vulnerable groups. It also can help with the broader

picture of human rights discourse, providing empirical data to support interventions that promote

and protect human rights.

Health professionals providing care within health delivery systems also have a critical

role in addressing special vulnerabilities in their patients. This starts with developing a level of

trust with vulnerable patients. Health professionals can begin developing trustworthiness by

recognizing vulnerabilities and willingness to trust based on context-specific assessment of

personality, culture, race, age, prior experiences, socioeconomic and political circumstances.95 A

patient’s approach to interactions with the health care system and health care providers may be

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affected by their particular vulnerabilities. Physicians must address this issue in their everyday

interaction with patients to effectively provide equitable health care.

Those with special vulnerability deserve special protection with respect for vertical

equity. There is a correlation between vulnerability factors and health care disparities in access,

treatment options, and prevention.96 Those facing special vulnerability face barriers and

obstacles to receiving the care that they need, that others without special vulnerability do not

face. This creates inequities in health care delivered and received. In addition, those with special

vulnerability have a greater likelihood of being wronged or denied legitimate claims to physical

integrity, autonomy, freedom, social provision, impartial quality of government, social basis of

self-respect or communal belonging.97 The denial of these legitimate claims have clear

implications for the realization of human rights – not just the right to health, but as a prerequisite

for the meaningful realization of all other human rights as well.

General and special vulnerability are interdependent since the special protection for those

who particularly vulnerable is based on fairly protecting what is due to everyone.98 All humans

are vulnerable, but some individual and environmental factors will cause the expression of

special vulnerabilities.

Social responsibility in health care explains why health care delivery organizations have

obligations to protect general and special vulnerabilities. This is supported by foundations of

social responsibility and confirmed by the social nature of health care.

2bii Social Responsibility in Health Care

The UNESCO Universal Declaration on Bioethics and Human Rights outlines the

principle of social responsibility for the right to health:

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“Taking into account that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition, progress in science and technology should advance: (a) access to quality health care and essential medicines, especially for the health of women and children, because health is essential to life itself and must be considered to be a social and human good; (b) access to adequate nutrition and water; (c) improvement of living conditions and the environment; (d) elimination of the marginalization and the exclusion of persons on the basis of any grounds; (e) reduction of poverty and illiteracy.” 99

Social responsibility in health care has many dimensions and includes access,

environmental issues, and reduction of health disparities. Social responsibility describes

the obligations that humans have toward one another based on social structures, norms

and obligations. Social responsibility also includes the obligations that organizations and

government bodies have toward the society in which they function, and individuals

within that society.

Foundations of Social Responsibility

Social responsibility is based on the social nature of humanity. The self is fundamentally

embedded in social world where values and emotions are directly related to social connection.100

Humans would not have a sense of self if not for social context. The emotions and understanding

that create the human experience are inextricably social. A person is defined and identifies him

or herself by the way in which he or she is perceived by others, and perception of the self

interacting with others. If a person asks oneself, “who am I?” the answer will be related to the

social world in which they live and breathe. For example, a person may answer this question by

describing their occupation, their familial obligations, or their personality. All of these answers

only have meaning within a social environment.

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The complexity of human social nature is what makes humans unique from other

animals. Humans are intensely social with a unique ability for high-level manipulation of social

information, consciousness, understanding of self and understanding of others.101 Humans have

the capacity to understand and synthesize social information to create definitions of themselves

and others. Social interactions are an essential element of human self-actualization. One knows

themselves and realizes their potential through interactions with others. A person would be

unable to discover who they were and what they were capable of without human relationships.

The social environment of an individual explains the social norms that they carry with

them, and how these norms affect their decision-making process. Social norms and socialization

can help to explain behaviors such as reciprocity, the norm of equity, and the norm of social

responsibility.102 Belief in reciprocity, or mutual exchange, is facilitated by social norms and the

socialization that one has experienced within their lifetime. A person’s belief is fairness, or

equity is likewise influenced by socialization and accepted social norms. The role of social

responsibility, the place of social responsibility, and beliefs related to how social responsibility

should be carried out is also influenced by this socialization process. A person’s worldview,

including the way in which humans should rightfully interact, is influenced by social norms that

a person has developed through socialization experiences.

The identity of an individual is dependent upon the social nature of human dignity. How

a person interprets their own identity and connection with other humans has significant

implications for health and wellbeing. The wellbeing of individuals is inextricably linked to the

wellbeing of others, and can be influenced by a host of social experiences such as plagues,

pandemics, wars, acts of terrorism, and advances in medical science.103 The influence of these

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social experiences can be positive or negative: negative, for example, in the case of plagues,

pandemics, and wars; and generally positive in the case of advances in medical science.

Overall, the social nature of humanity has positive effects on well-being and health.

Social arrangements can enable mutual advantage for participants that is a greater sum than its

parts – including greater economic opportunities and freedom to self-actualize.104 Of course, this

ability to gain greater economic opportunities and self-actualization only occur when there are

fair terms. Equal participation in democracy can be hindered if social arrangements are not

established in foundations of equity.

The advantages of the social nature of humans can be explained in terms of social capital.

Social capital, or productive social cohesion, allows individuals to share collective energy and

benefit from social support.105 What a social group can accomplish together is more than the sum

of its parts. People working in social groups can synergize and accomplish more as a social

group than they could have individually. Social capital is the economic benefit of socialization,

where social support systems are turned into energy or productivity. Social capital explains why

social group membership is beneficial for humans from an economic perspective.

This productivity is especially profound when it is inclusive of the whole population.

Inclusive growth through education and health creates a more productive labor force by

increasing productive employment opportunities for all, removing social constraints and

contributing to the overall economic growth and welfare of society.106 This means that societies

are more productive when there is more equity in health and education. A healthy population has

a larger and more productive workforce than an unhealthy population. Investing in health and

education has positive implications for economic growth and social stability.

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Prioritizing social concerns, especially in policy discussions, has been met with some

resistance in the United States. This is because social norms in the United States tend to favor

individualism, or favoring self and one’s own circle over greater societal concerns.

Unfortunately, staunch individualism can ultimately diminish, rather than enhance, freedom

unless it is balanced with forms of cultural practice and a greater vision of social solidarity.107

When individualism is not balanced with social solidarity, corporate control can become the

dominant economic power and political influence, rather than democratic control of citizens.

The social nature of the human condition brings about responsibilities based on social

conditions. Responsibility occurs when an actor has freedom of will or action and

blameworthiness.108 In other words, responsibility occurs when an entity has freely acted to bring

about a consequence.109 When a person freely acts, he or she has the capacity to be deliberate,

and the deliberate action brings about a consequence – that person is responsible for the action.

The social nature of being human creates responsibilities related to social consequences. If a

social consequence is caused by a freely acting, deliberate entity, then that entity is responsible

for the social consequence of that action.

Social responsibility is related to protection of the most vulnerable individuals and groups

in the society, and promoting equity among all persons. Social responsibility can be carried out

by individuals, institutions, and governments. Governments often fulfil moral obligations to help

the poor based on responsibility to society, although policy fixes directly related to welfare may

only go so far to address the complex social issues including racial wounds, education, and

employment opportunity.110 The institutions and individuals within a society are in an effective

position to have meaningful influence on some of these significant social issues affecting poverty

and health outcomes.

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Balancing individualism with social solidarity can be facilitated through social

responsibility, making social responsibility a useful concept for social institutions in the United

States. Social responsibility – which includes responsibility for impact of behaviors on others,

activities that benefit others, cooperation in social groups and basic concern for others – helps to

enhance one’s own meaning of life and gain perspective on one’s own problems.111 Actions

founded in social responsibility create positive outcomes for the recipient of services, but also

the provider of services. Acting in a socially conscious way provides a better sense of self

because it provides evidence of one’s place in the world.

Humans are both biological and social beings who engage with environments and

societies to create patterns of health, disease and well-being.112 Health care is inherently social

because of the connection between environments and the patterns of health, disease and well-

being. Social environment has a causal relationship with health and disease, and addressing

social dimensions of health is needed to support health and well-being.

The Social Dimension of Health Care

Disease is experienced, defined, and addressed through the complex domain of human

experience that provides its explanation, expectation and meaning.113 Thus, social and

environmental responses to disease management are crucial components of treatments and

therapies. Humans experience and understand disease through their social understanding of

health and illness. A person’s expectation about the disease process and treatment, as well as

how they interpret its meaning is based on social understanding of health and disease.

The social dimension of health care explains its responsibility to protect the right to

health care. Rights, including the right to health, are both positive and negative. Negative rights

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involve the elimination of infringements upon individual liberties (such as right to free speech,)

while positive rights involve obligations to work toward goals that facilitate access and

conditions that make individual liberties possible (such as right to a fair trial.)114 There are both

positive and negative rights related to the right to health. Negative right to health involves

eliminating infringements upon ability to obtain the highest attainable level of health. This

involves removing barriers or obstacles to achieving health. Removing barriers to health related

to social determinants of health would be an example of responsibilities related to the negative

right to health. The positive right to health includes obligations to facilitate access to conditions

that make health possible. This includes providing available, accessible, acceptable, quality

health care for all persons.

The obligations to protect and promote the right to health lie within health care delivery

organizations, including administrative leadership, providers and staff. Health care delivery

organizations have a social obligation to improve quality of life within the communities they

serve.115 This is due to the nature of health care delivery. The purpose of a health care delivery

organization is to improve the health of the population it serves. The actions it facilitates and

policies it employs have a direct impact on individuals and communities it serves. The health

care delivery organization has responsibility because of the deliberate action it takes that has

direct impact on health of individuals and communities.

Health care delivery institutions have social responsibility in that they carry out deliberate

actions that create significant social consequences. The actions facilitated by health care delivery

organizations result in allocation of health care resources, and thereby allocation of health

opportunity. Health is a prerequisite for a productive, well-functioning society, so the decisions

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that health care delivery organizations make – especially in terms of resource allocation – have

explicit social consequences.

Human decision-making is performed within a social environment. Decisions are not

made in a vacuum. Individuals weigh the implications of decisions in relation to their social

context. Decisions about health and well-being are made in a social context which affect

individual rational decision-making, so people's choices are seldom genuinely, fully autonomous

and a purely individualistic approach to health improvement is inadequate.116 Approaching

health care as though individuals make siloed, fully autonomous decisions will leave crucial

components of the patient’s needs and decision-making processing out. Humans can only be

fully cared for with consideration of their social environment. The implications for health equity

and respect for human vulnerability can also only be fully considered within the social context.

Health care delivery systems have social responsibility and are social organizations.

Health care is a social good, and should not be commodified based on the ethical dimensions of

health care goods and services. These ethical dimensions are based on equity, respect for human

vulnerability and social responsibility. The commodification of healthcare can create barriers to

access for the most vulnerable and distort the dynamic of healthcare delivery. Instead, a rights-

based approach should be used to develop equitable structures including financial and

infrastructure resources.117 The purpose of a health care delivery system is to provide a social

good, and so has social responsibilities along with this purpose. A rights-based approach will

facilitate equitable, socially responsible healthcare delivery.

The right to health is realized through health delivery organizations. The realization of

the fundamental right to health must be reasonable, progressive and subject to continuous

improvement, availability of resources, accountability, evidence-based standards, and must be

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translated into health policies and interventions, practical applications, health practice, and health

interventions.118 Health care delivery organizations must take reasonable actions that

progressively address the human right to health through continuous improvement. Availability of

resources and accountability for actions is a key component of successfully promoting this right.

Evidence-based standards can be used to develop policies and interventions that can be used in

health practice and practical interventions.

The social responsibility of health care delivery organizations is evident, but honoring

this social responsibility is more difficult than simply recognizing it. Social institutions have

been built to provide security and protection of human ontological vulnerability, although these

institutions face inevitable social conflict due to scarce resources, human degradation of the

environment, and competition for limited space.119 Allocation of resources remains a challenge

to health care delivery and the practical implementation of the right to health. When there are

limited resources, allocating health care goods and services equitably, respecting both general

human vulnerability and special vulnerability, and honoring social responsibility is a major

challenge for health care delivery organizations. A human rights approach will help to clarify

ethical resource allocation within health care delivery organizations.

Health care delivery organizations are as important for health and human rights discourse

as state actors in health and human rights. There is a significant impact on health created by non-

state actors, which transcends conventional human rights discourse.120 Although conventional

human rights discourse has focused on state actors, the human right to health is carried out

through health care delivery organizations. These organizations must have standards to protect

health equity, based on their social responsibility to protect and respect human vulnerability.

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Health and human rights has, until now, been general and focused on broad, non-specific

state-level protections. Now, health and human rights should move from general to specific

practice guidelines on health issues, defining core obligations that can be universally applied, as

well as the duty-bearers of this right.121 This should be translated to the responsibilities held by

health care delivery organizations. Health care delivery organizations have explicit social

responsibility to protect these rights, and have the capability to impact the protection of health

and human rights in a meaningful way.

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1 Hunt, Lynn.  Inventing Human Rights. A History. W.W. Norton & Company, New York/London, 2008. 116‐117. 2 Hunt, Lynn.  Inventing Human Rights. A History. W.W. Norton & Company, New York/London, 2008. 118‐126. 3 Hunt, Lynn.  Inventing Human Rights. A History. W.W. Norton & Company, New York/London, 2008. 127‐145. 4 Hunt, Lynn.  Inventing Human Rights. A History. W.W. Norton & Company, New York/London, 2008. 113‐116. 5 Pinto, Andrew D. and Upshur, Ross E.G. (eds.): An introduction to global health ethics. Routledge, London and New York, 2013. 48‐49. 

6 Constitution of the World Health ORganization . Geneva: World Health Organization; 1948. 7 Rothman, David J.  and Rothman, Sheila M. Trust is not enough. Bringing human rights to medicine. New York Review of Books, New York, 2006. 154‐155 

8 Pinto, Andrew D. and Upshur, Ross E.G. (eds.): An introduction to global health ethics. Routledge, London and New York, 2013. 8‐9 

9 United Nations. “Universal Declaration of Human Rights” (Dec 1948) http://www.un.org/en/universal‐declaration‐human‐rights/ 

10 UNESCO. “Universal Declaration on Bioethics and Human Rights.” (Oct 2015.) http://portal.unesco.org/en/ev.php‐URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html 

11 United Nations. “Sustainable Development Goals.” (2015.)  http://www.un.org/sustainabledevelopment/sustainable‐development‐goals/ 

12 United Nations. “Goal 3: Ensure healthy lives and promote well‐being for all at all ages.” (2015.) http://www.un.org/sustainabledevelopment/health/ 

13 World Health Organization. “Health and Human Rights.” Factsheet No 323. (Dec 2015.) http://www.who.int/mediacentre/factsheets/fs323/en/ 

14 United Nations. “Sustainable Development Goals: 17 Goals to Transform Our World.” (Sept 2015.) http://www.un.org/sustainabledevelopment/sustainable‐development‐goals/ 

15 Annas, George J. "Human Rights." In Bioethics, edited by Bruce Jennings, 1612‐18. Farmington Hills, MI: Macmillan Reference USA, 2014. 

16 Yamin, Alicia Ely, and Paul Farmer. Power, Suffering, and the Struggle for Dignity : Human Rights Frameworks for Health and Why They Matter.  Philadelphia, UNITED STATES: University of Pennsylvania Press, 2015. (26‐41) 

17 Acharya, Lalatendu. "Encyclopedia of Human Services and Diversity."  Thousand Oaks, California: SAGE Publications, Inc., 2014. 

18 UN Committee on Economic, Social and Cultural Rights (CESCR). “General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant).” (August 2000.) 

19 UN Committee on Economic, Social and Cultural Rights (CESCR). “General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant).” (August 2000): 4. 

20 Ansell, Dominique, James A. G. Crispo, Benjamin Simard, and Lise M. Bjerre. "Interventions to Reduce Wait Times for Primary Care Appointments: A Systematic Review." BMC Health Services Research 17 (2017). 

21 Qato, Dima Mazen, Shannon Zenk, Jocelyn Wilder, Rachel Harrington, Darrell Gaskin, and G. Caleb Alexander. "The Availability of Pharmacies in the United States: 2007‐2015." PLoS One 12, no. 8 (Aug 2017). 

22 Gunn, Jennifer L. "Meeting Rural Health Needs: Interprofessional Practice or Public Health?" Nursing History Review 24 (2016): 90‐97. 

23 Schoo, Adrian, Sharon Lawn, and Dean Carson. "Towards Equity and Sustainability of Rural and Remote Health Services Access: Supporting Social Capital and Integrated Organisational and Professional Development."  BMC Health Services Research 16 (2016). 

24 Liu, Tsai‐Ling, A. SidneyBarritt Iv, Morris Weinberger, John E. Paul, Bruce Fried, and Justin G. Trogdon. "Who Treats Patients with Diabetes and Compensated Cirrhosis." PLoS One 11, no. 10 (Oct 2016). 

25 Cheshire, William P. J. R. M. D. "Telemedicine and the Ethics of Medical Care at a Distance." Ethics & Medicine 33, no. 2 (Summer 2017): 71‐75,67. 

26 Cassie Cunningham, Goedken, Jane Moeckli, Peter M. Cram, and Reisinger Heather Schacht. "Introduction of Tele‐Icu in Rural Hospitals: Changing Organisational Culture to Harness Benefits." Intensive & Critical Care Nursing 40 (2017): 51‐56. 

                                                            

Page 99: An Ethical Framework for Organizational Resource

 

91

                                                                                                                                                                                                27 Shankel, Erin Christine D. N. P. R. N. F. N. P. B. C., and Linda G. D. N. P. R. N. Cpnp Wofford. "Symptom Management Theory as a Clinical Practice Model for Symptom Telemonitoring in Chronic Disease." Journal of Theory Construction & Testing 20, no. 1 (Spring/Summer 2016): 31‐38. 

28 UN Committee on Economic, Social and Cultural Rights (CESCR). “General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant).” (August 2000): 4. 

29 Tao, Wenjing, Janne Agerholm, and Bo Burstrom. "The Impact of Reimbursement Systems on Equity in Access and Quality of Primary Care: A Systematic Literature Review." BMC Health Services Research 16 (2016). 

30 Gavriloff, Carrie, Sarah Ostrowski‐Delahanty, and Kimberly Oldfield. "The Impact of Lean Six Sigma Methodology on Patient Scheduling." Nursing Economics 35, no. 4 (Jul/Aug 2017): 189‐93. 

31 Matthew Lee, Smith, Thomas R. Prohaska, Kara E. MacLeod, Marcia G. Ory, Amy R. Eisenstein, David R. Ragland, Cheryl Irmiter, Samuel D. Towne, and William A. Satariano. "Non‐Emergency Medical Transportation Needs of Middle‐Aged and Older Adults: A Rural‐Urban Comparison in Delaware, USA." International Journal of Environmental Research and Public Health 14, no. 2 (2017): 174. 

32 Park, Seri, and Tamara M. Kear. "Current State‐of‐Practice: Transportation for Patients with End Stage Renal Disease." Nephrology Nursing Journal 44, no. 4 (Jul/Aug 2017): 309‐15. 

33 Satyamurthy, Shruthi M. B. A. M. H. A., and Daniel PhD Montanera. "Racial Concentration as a Determinant of Access to Health Care in Georgia." International Journal of Child Health and Human Development 9, no. 4 (2016): 3‐14. 

34 Hwang, Stephen W. M. D. M. P. H., Joanna J. M. B. A. Ueng, Shirley M. A. Chiu, Alex PhD Kiss, George PhD M. P. H. Tolomiczenko, Laura BScN Cowan, Wendy M. D. Levinson, and Donald A. M. D. Mshsr Redelmeier. "Universal Health Insurance and Health Care Access for Homeless Persons." American Journal of Public Health 100, no. 8 (Aug 2010): 1454‐61. 

35 Burke, Nancy J., Tessa M. Napoles, Priscilla J. Banks, Fern S. Orenstein, Judith A. Luce, and Galen Joseph. "Survivorship Care Plan Information Needs: Perspectives of Safety‐Net Breast Cancer Patients." PLoS One 11, no. 12 (Dec 2016). 

36 Amirsadri, Alireza, Jaclynne Burns, Albert Pizzuti, and Cynthia L. Arfken. "Home‐Based Telepsychiatry in Us Urban Area." Case Reports in Psychiatry (2017). 

37 Hsia, Renee Yuen‐Jan, and Yu‐Chu Shen. "Rising Closures of Hospital Trauma Centers Disproportionately Burden Vulnerable Populations." Health Affairs 30, no. 10 (Oct 2011): 1912‐20. 

38 UN Committee on Economic, Social and Cultural Rights (CESCR). “General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant).” (August 2000): 5. 

39 Grill, Kalle. "Incentives, Equity and the Able Chooser Problem." Journal of Medical Ethics 43, no. 3 (Mar 2017): 157. 

40 Yi Feng, Lai, Lum Andrew Yew Wai, Ho Emily Tse Lin, and Lim Yee Wei. "Patient‐Provider Disconnect: A Qualitative Exploration of Understanding and Perceptions to Care Integration." PLoS One 12, no. 10 (Oct 2017). 

41 Pega, Frank, Nicole B. Valentine, Kumanan Rasanathan, Ahmad Reza Hosseinpoor, Tone P. Torgersen, Veerabhadran Ramanathan, Tipicha Posayanonda, et al. "The Need to Monitor Actions on the Social Determinants of Health." World Health Organization. Bulletin of the World Health Organization 95, no. 11 (Nov 2017): 784‐87. 

42 Chatfield, J. Seth PhD, Clinton O. PhD Longenecker, Laurence S. PhD Fink, and Jeffrey P. M. D. Gold. "Ten Ceo Imperatives for Healthcare Transformation: Lessons from Top‐Performing Academic Medical Centers." Journal of Healthcare Management 62, no. 6 (Nov/Dec 2017): 371‐83. 

43 Kte'pi, Bill. "Equity and Equality." In Multicultural America: A Multimedia Encyclopedia, edited by Carlos E. Cortés Thousand Oaks, California: SAGE Publications, Inc., 2013. 

44 UNESCO. “Universal Declaration on Bioethics and Human Rights.” (Oct 2015.) http://portal.unesco.org/en/ev.php‐URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html 

45 Rothman and Rothman 119‐120 46 Gusmano, Michael K. "Access to Health Care." In Bioethics, edited by Bruce Jennings, 77‐81. Farmington Hills, MI: Macmillan Reference USA, 2014. 

47 Powers, Madison. "Social Justice." In Bioethics, edited by Bruce Jennings, 2966-73. Farmington Hills, MI: Macmillan Reference USA, 2014. 2970-2972 48 Massetti, G. M., C. C. Thomas, and K. R. Ragan. "Disparities in the Context of Opportunities for Cancer Prevention in Early Life." Pediatrics 138, no. Suppl 1 (Nov 2016): S65-S77. 

Page 100: An Ethical Framework for Organizational Resource

 

92

                                                                                                                                                                                                49 Marmot, Michael. "Achieving Health Equity: From Root Causes to Fair Outcomes." The Lancet 370, no. 9593 (2007):

1153-63. 50 Odekon, Mehmet. " Equity in Health” The Sage Encyclopedia of World Poverty Thousand Oaks, California: SAGE

Publications, Inc, 2015. 51 Rust, G., S. Zhang, K. Malhotra, L. Reese, L. McRoy, P. Baltrus, L. Caplan, and R. S. Levine. "Paths to Health Equity: Local Area Variation in Progress toward Eliminating Breast Cancer Mortality Disparities, 1990-2009." Cancer 121, no. 16 (Aug 15 2015): 2765-74. 52 Brudney, D. "Is Health Care a Human Right?". Theor Med Bioeth 37, no. 4 (Aug 2016): 249-57. 53 Hosseinpoor, Ahmad Reza, Nicole Bergen, and Anne Schlotheuber. "Promoting Health Equity: Who Health Inequality Monitoring at Global and National Levels." Global Health Action 8 (2015). 

54 Wei‐Ching, Chang, and Joy H. Fraser. "Cooperate! A Paradigm Shift for Health Equity." International Journal for Equity in Health 16 (2017). 

55 Odekon, Mehmet. "Equity and Efficiency Tradeoff." In The SAGE Encyclopedia of World Poverty Thousand Oaks Thousand Oaks, California: SAGE Publications, Inc, 2015. 56 Ndumbe‐eyoh, Sume, and Agnes Mazzucco. "Social Media, Knowledge Translation, and Action on the Social Determinants of Health and Health Equity: A Survey of Public Health Practices." Journal of Public Health Policy 37 (Nov 2016): 249‐59. 

57 Wilkinson, G. W., A. Sager, S. Selig, R. Antonelli, S. Morton, G. Hirsch, C. R. Lee, et al. "No Equity, No Triple Aim: Strategic Proposals to Advance Health Equity in a Volatile Policy Environment." Am J Public Health 107, no. S3 (Dec 2017): S223-S28. 58 Lawrence, David M. D., Lauren M. D. Weigel, Paul M. D. Dale, Betsy Drph Smith, and Michael D. M. D. Honaker. "Presenting Stage in Colon Cancer Is Associated with Insurance Status." The American Surgeon 83, no. 7 (Jul 2017): 728‐32. 

59 Latham, Stephen R. "Justice and the Financing of Health Care." In The Blackwell Guide to Medical Ethics, 341‐53: Blackwell Publishing Ltd, 2008. 

60 Venkatapuram, Sridhar, Hans‐Jörg Ehni, and Abha Saxena. "Equity and Healthy Ageing." World Health Organization. Bulletin of the World Health Organization 95, no. 11 (Nov 2017): 791‐92. 

61 Dharssi, Safiyya, Durhane Wong‐Rieger, Matthew Harold, and Sharon Terry. "Review of 11 National Policies for Rare Diseases in the Context of Key Patient Needs." Orphanet Journal of Rare Diseases 12 (2017). 

62 Shadmi, Efrat. "Multimorbidity and Equity in Health." International Journal for Equity in Health 12 (2013): 59. 63 Rust, G., R. S. Levine, Y. Fry-Johnson, P. Baltrus, J. Ye, and D. Mack. "Paths to Success: Optimal and Equitable Health Outcomes for All." J Health Care Poor Underserved 23, no. 2 Suppl (May 2012): 7-19. 64 Cooper, L. A., T. S. Purnell, C. A. Ibe, J. P. Halbert, L. R. Bone, K. A. Carson, D. Hickman, et al. "Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities." Ethn Dis 26, no. 3 (Jul 21 2016): 369-78. 65 Payne, G. H., S. D. James, Jr., L. Hawley, B. Corrigan, R. E. Kramer, S. N. Overton, R. P. Farris, and Y. Wasilewski. "Cdc's Health Equity Resource Toolkit: Disseminating Guidance for State Practitioners to Address Obesity Disparities." Health Promot Pract 16, no. 1 (Jan 2015): 84-90. 66 Liao, S. M. "Health (Care) and Human Rights: A Fundamental Conditions Approach." Theor Med Bioeth 37, no. 4 (Aug 2016): 259-74. 67 UNESCO. “Universal Declaration on Bioethics and Human Rights.” (Oct 2015.) http://portal.unesco.org/en/ev.php‐URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html 

68 Chapman, Audrey R., and Benjamin Carbonetti. "Human Rights Protections for Vulnerable and Disadvantaged Groups: The Contributions of the Un Committee on Economic, Social and Cultural Rights." Human Rights Quarterly 33, no. 3 (Aug 2011): 682‐732,922‐23. 

69 Rogers, Wendy A., Catriona Mackenzie, and Susan Dodds. "Vulnerability." In Bioethics, edited by Bruce Jennings, 3149‐53. Farmington Hills, MI: Macmillan Reference USA, 2014. 

70 "Vulnerability." In International Encyclopedia of the Social Sciences, edited by William A. Darity, Jr., 656‐57. Detroit: Macmillan Reference USA, 2008. 

71 Hardy, Jan, and Tina Barrows. "Key Concepts in Public Health: Vulnerability."  London: SAGE Publications Ltd, 2009.  

Page 101: An Ethical Framework for Organizational Resource

 

93

                                                                                                                                                                                                72 Teunissen, G. J., M. A. Visse, and T. A. Abma. "Struggling between Strength and Vulnerability, a Patients' Counter Story." Health Care Analysis 23, no. 3 (2017-03-21 2015): 288-305. 73 Hoffmaster, Barry. "What Does Vulnerability Mean?" Hastings Center Report 36, no. 2 (2017-03-21 2006): 38-45. 74 Have, H. ten. Vulnerability : Challenging Bioethics Abingdon, Oxon: Routledge, 2016. Book. 2-3 75 Blacksher, Erika, and John R. Stone. "Introduction to Vulnerability Issues of Theoretical Medicine and Bioethics." Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice 23, no. 6 (2017-03-21 2002): 421-24. 76 Solbakk, Jan Helge. "Vulnerability: A Futile or Useful Principle in Healthcare Ethics?"  London: SAGE Publications Ltd, 2011.. 

77 Council for International Organizations of Medical Sciences. International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva: 2002. 

78 Vehmas, Simo, and T. O. M. Shakespeare. "Disability, Harm, and the Origins of Limited Opportunities." Cambridge Quarterly of Healthcare Ethics 23, no. 1 (Jan 2014): 41‐7. 

79 Peroni, Lourdes, and Alexandra Timmer. "Vulnerable Groups: The Promise of an Emerging Concept in European Human Rights Convention Law." International Journal of Constitutional Law 11, no. 4 (October 2013): 1056‐85. 

80 Sellman, Derek. "Towards an Understanding of Nursing as a Response to Human Vulnerability." Nursing Philosophy: An International Journal for Healthcare Professionals 6, no. 1 (2017-03-21 2005): 2-10. 81 Curtis, Andrew J., and Wei‐An Andy Lee. "Spatial Patterns of Diabetes Related Health Problems for Vulnerable Populations in Los Angeles." International Journal of Health Geographics 9 (2010): 43. 

82 Wilson, Sacoby, Hongmei Zhang, Chengsheng Jiang, Kristen Burwell, Rebecca Rehr, Rianna Murray, Laura Dalemarre, and Charles Naney. "Being Overburdened and Medically Underserved: Assessment of This Double Disparity for Populations in the State of Maryland." Environmental Health 13 (2014): 26. 

83 Stone, John R. "Race and Healthcare Disparities: Overcoming Vulnerability." Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice 23, no. 6 (2017-03-21 2002): 499-518. 84 Engelman, Michal, Christopher L. Seplaki, and Ravi Varadhan. "A Quiescent Phase in Human Mortality? Exploring the Ages of Least Vulnerability." Demography 54, no. 3 (Jun 2017): 1097‐118. 

85 Braveman, Paula. "What Is Health Equity: And How Does a Life‐Course Approach Take Us Further toward It?" Maternal and Child Health Journal 18, no. 2 (Feb 2014): 366‐72. 

86 Bonevski, Billie, Madeleine Randell, Chris Paul, Kathy Chapman, Laura Twyman, Jamie Bryant, Irena Brozek, and Clare Hughes. "Reaching the Hard‐to‐Reach: A Systematic Review of Strategies for Improving Health and Medical Research with Socially Disadvantaged Groups." BMC Medical Research Methodology 14 (20144): 42. 

87 National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Bethesda, Md.: The Commission, 1978. 

88 18th World Medical Association General Assembly. Declaration of Helniski: Ethical Principles for Medical Research Involving Human Subjects. Helinski, Finland: (June 1964.) 

89 64thWorld Medical Association General Assembly. Declaration of Helniski: Ethical Principles for Medical Research Involving Human Subjects. Fortaleza, Brazil: (Oct 2013.) 

90 Bosch‐Capblanch, Xavier, Zuske Meike‐Kathrin, and Christian Auer. "Research on Subgroups Is Not Research on Equity Attributes: Evidence from an Overview of Systematic Reviews on Vaccination." International Journal for Equity in Health 16 (2017). 

91 Willen, Sarah S., Michael Knipper, César E. Abadía‐Barrero, and Nadav Davidovitch. "Syndemic Vulnerability and the Right to Health." The Lancet 389, no. 10072 (2017): 964‐77. 

92 Zagorac, Ivana PhD. "How Should We Treat the Vulnerable? Qualitative Study of Authoritative Ethics Documents." Journal of Health Care for the Poor and Underserved 27, no. 4 (Nov 2016): 1656‐73. 

93 Drewes, Y. M., J. W. Blom, W. J. Assendelft, T. Stijnen, W. P. den Elzen, and J. Gussekloo. "Variability in Vulnerability Assessment of Older People by Individual General Practitioners: A Cross-Sectional Study." PLoS One 9, no. 11 (2014): e108666. 94 Bambas, Lexi. "Integrating Equity into Health Information Systems: A Human Rights Approach to Health and Information." PLoS Medicine 2, no. 4 (Apr 2005): e102. 

95 Barnard, David. "Vulnerability and Trustworthiness: Polestars of Professionalism in Healthcare." Cambridge Quarterly of Healthcare Ethics 25, no. 2 (2017-03-21 2016): 288-300. 96 Grabovschi, Cristina, Christine Loignon, and Martin Fortin. "Mapping the Concept of Vulnerability Related to Health Care Disparities: A Scoping Review." BMC Health Services Research 13 (2013): 94. 

Page 102: An Ethical Framework for Organizational Resource

 

94

                                                                                                                                                                                                97 Tavaglione, Nicolas, Angela K. Martin, and Nathalie Mezger. "Fleshing out Vulnerability." Bioethics 29, no. 2 (2017-03-21 2015): 98-107. 98 Martin, Angela K., Nicolas Tavaglione, and Samia Hurst. "Resolving the Conflict: Clarifying 'Vulnerability' in Health Care Ethics." Kennedy Institute of Ethics Journal 24, no. 1 (Mar 2014): 51‐72. 

99 UNESCO. “Universal Declaration on Bioethics and Human Rights.” (Oct 2015.) http://portal.unesco.org/en/ev.php‐URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html 

100 Gardner, Wendi L., and Kristy K. Dean. "Interdependent Self‐Construals." In Encyclopedia of Social Psychology, edited by Roy F. Baumeister and Kathleen D. Vohs, 490‐92. Thousand Oaks, CA: SAGE Publications, 2007. 

101 Adolphs, Ralph. "Cognitive Neuroscience of Human Social Behaviour." Nature Reviews. Neuroscience 4, no. 3 (Mar 2003): 165-78. 

102 Kilpatrick, Shelley Dean. "Helping Behavior." In Encyclopedia of Social Psychology, edited by Roy F. Baumeister and Kathleen D. Vohs, 420-24. Thousand Oaks, CA: SAGE Publications, 2007. 103 "Declaration of Professional Responsibility Medicine's Social Contract with Humanity." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2692. New York: Macmillan Reference USA, 2004. 104 Powers, Madison. "Social Justice." In Bioethics, edited by Bruce Jennings, 2966-73. Farmington Hills, MI: Macmillan Reference USA, 2014. 2966 -2970 105 Hsieh, Ching-Hsing PhD R. N. "A Concept Analysis of Social Capital within a Health Context." Nursing Forum 43, no.

3 (2008): 151-9. 106 Dinda, Soumyananda. "Inclusive Growth through Creation of Human and Social Capital." International Journal of

Social Economics 41, no. 10 (2014): 878-95. 107 Madsen, Richard. "Individualism." In Encyclopedia of Community, edited by Karen Christensen and David Levinson, 648‐51. Thousand Oaks, CA: SAGE Reference, 2003. 108 Zimmerman, Michael J. "Responsibility." In New Dictionary of the History of Ideas, edited by Maryanne Cline Horowitz, 2110‐12. Detroit: Charles Scribner's Sons, 2005. 

109 Kaufman, Arnold S. "Responsibility, Moral and Legal." In Encyclopedia of Philosophy, edited by Donald M. Borchert, 444‐51. Detroit: Macmillan Reference USA, 2006. 

110 Kerby, Rob. "Welfare and Poverty." In Encyclopedia of Politics, edited by Rodney P. Carlisle. The Left, 489-91. Thousand Oaks, CA: SAGE Reference, 2005. 111 "How to Increase Socially Responsible Change." In Change Management Excellence, edited by Sarah Cook, Steve Macaulay and Hilary Coldicott, 210-14. London: Kogan Page, 2004. 112 Krieger, N. "Health Equity and the Fallacy of Treating Causes of Population Health as If They Sum to 100." Am J Public Health 107, no. 4 (Apr 2017): 541-49. 113 Jones, David S. M. D. PhD, Scott H. M. D. Podolsky, and Jeremy A. M. D. PhD Greene. "The Burden of Disease and

the Changing Task of Medicine." The New England Journal of Medicine 366, no. 25 (2012): 2333-8. 114 Kronenfeld, Jennie, Wendy Parmet, and Mark Zezza. "Debates on U.S. Health Care: Health Care as a Human Right." Thousand Oaks, California: SAGE Publications, Inc., 2012. 

115 Kopolow, Andrew M., and Louis E. Kopolow. "Corporate Social Responsibility in Health." In Bioethics, edited by Bruce Jennings, 715‐18. Farmington Hills, MI: Macmillan Reference USA, 2014. 

116 Ahola‐Launonen, Johanna. "The Evolving Idea of Social Responsibility in Bioethics." Cambridge Quarterly of Healthcare Ethics 24, no. 2 (Apr 2015): 204‐13. 

117 Christiansen, Isaac. "Commodification of Healthcare and Its Consequences." World Review of Political Economy 8, no. 1 (Spring 2017): 82‐103. 

118 Bustreo, Flavia, and Paul Hunt. "The Right to Health Is Coming of Age: Evidence of Impact and the Importance of Leadership." Journal of Public Health Policy 34, no. 4 (Nov 2013): 574‐9. 

119 Turner, Bryan. "The Rights of Age: On Human Vulnerability." In Sociology and Human Rights: A Bill of Rights for the Twenty-First Century Thousand Oaks, California: SAGE Publications, Inc., 2012 

120 Osuji, Onyeka K., and Ugochukwu L. Obibuaku. "Rights and Corporate Social Responsibility: Competing or Complementary Approaches to Poverty Reduction and Socioeconomic Rights?" Journal of Business Ethics 136, no. 2 (Jun 2016): 329‐47. 

121 Hunt, P. "Interpreting the International Right to Health in a Human Rights-Based Approach to Health." Health Hum Rights 18, no. 2 (Dec 2016): 109-30. 

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Chapter 3: Patient Care Quality & Patient Safety

3a Patient Care Quality & Patient Safety as a Function of Human Rights

Patient care quality is a function of human rights. For humans to meaningfully exercise

their human rights, they must be healthy and vice versa. This section will first define quality in

health care and then discuss quality in terms of human rights.

Quality in health care can be partially defined through the “triple aim” of health care

quality: care quality, patient experience and cost. Quality care also encompasses patient safety.

First, this section will provide definitions for these key components of quality in health care.

Second, this section will describe how these aims of quality in health care should be incorporated

with discourse on the human right to health. This includes the imperative to reduce disparities in

health care and defining standards of care that should be protected. Although a conceptual

definition of health and human rights has already been developed, ways in which this right

should be carried out or carried out in the everyday practice of health delivery organizations has

not yet been defined. This section will explain how the right to health specifically requires that

all individuals have access to quality health care.

3ai Defining Quality in Health Care

Quality in health care encompasses patient safety, health outcomes, associated processes,

patient experiences and costs that result from health care delivery. Patient safety requires that a

patient protected from harm, avoidable adverse events and medical error. The “triple aim” of

quality is also useful in this description, which describes improving health, improving patient

experience, and reducing costs.1 Assessment of overall quality in health care should include

considerations of these four domains.

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Patient Safety

Patient safety includes prevention of medical errors, prevention of avoidable adverse

events, protection of patients from harm or injury, and healthcare provider collaboration within

the integrated health system.2

In 2000, patient safety rose to prominence through the Institute of Medicine (IOM)

released a landmark report: To Err Is Human: Building a Safer Health System. To Err Is Human

reported that 44,000-98,000 people die in hospitals because of medical error each year.3 In 2001,

the IOM followed up on To Err is Human with Crossing the Quality Chasm: A New Healthcare

System for the 21st Century. Crossing the Quality Chasm Six aims for improvement, stating that

health care should be safe, effective, patient‐centered, timely, efficient, and equitable.4 Following

these reports, the Joint Commission established the National Patient Safety Goals in 2002.5

These have evolved since their initial development and, as of 2018, include goals in the areas of

ambulatory health care, behavioral health care, critical access hospitals, home car, hospitals,

laboratory services, nursing care centers and office-based surgery.6 The National Quality Forum

(NQF) also developed a list of serious reportable events. These include serious, largely

preventable harmful clinical events in the domains of surgical or invasive procedures, products

or devices, patient protections, care management, environmental events, radiologic events, and

potential criminal events.7 Other programs to reduce patient safety events include the Centers for

Medicare and Medicaid services (CMS,) the Institute for Healthcare Improvement (IHI) and the

Agency for Healthcare Research and Quality (AHRQ.)

The Centers for Medicare and Medicaid Services (CMS) has implemented initiatives to

improve patient safety through reimbursement programs. These include reimbursement-related

incentives tied to patient safety indicators (PSIs) such as death among surgical inpatients with

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serious treatable complications.8 The Institute for Healthcare Improvement (IHI) has also

focused on patient safety and safety culture. The IHI works with health care providers to develop

integrated safety across the continuum of care, leadership methods to address safety, and

approaches to address patient safety issues.9 In addition, the AHRQ has developed tools and

resources for health care delivery systems and providers to improve patient safety.10

Organizations that focus on improving patient safety address the need for a patient safety

culture. Patient safety takes more than capital investment in buildings and infrastructure; It

requires organizational management approaches and targeted strategies to promote safety

culture.11 There are various tools that can help health care leaders to develop a culture of safety

within their organizations. A culture of safety must be implemented wisely, however, where

adverse events versus preventable adverse events versus negligent error are assessed.12 An

effective assessment of events and errors involves the integration of a just culture within the

culture of safety. A just culture requires that administrators recognize errors from faulty systems

but also hold staff responsible for choices, holding them accountable when necessary.13 A just

culture will help health care administrators, providers and staff to face accountability without

unnecessary blame. Safety incidents are usually due to faulty systems.

Faulty systems are often seen in communication and patient transition events. Common

safety incidents related to patient transitions, such as referrals and discharges, can be addressed

by developing a structured, integrated approach to transitional safety.14 There are clear roles for

health administration, providers, and staff in transitional safety. During shift-handoffs, nursing

staff have a high risk of communication related safety events. Intra-shift handoff effectiveness

has a significant impact on patient safety. Leaders should promote intra-shift handoff

communication by valuing nursing knowledge, supporting improvements in safety culture with

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positive working relationships, facilitating open dialogue, providing adequate staffing resources,

allowing for sufficient time with patients, decreasing distractions and noise, providing dedicated

handoff time, minimizing concomitant meetings, providing opportunities for continued learning,

and providing structured but flexible written tools for handoff.15 Clear communication between

shift handoffs, as well as interdisciplinary communication among providers and staff can reduce

avoidable adverse events. Transparency is also a useful tool for improving communication and

clarity of patient hand-offs and interdisciplinary communication.

Transparency can be used to improve leadership accountability, clinician engagement,

patient trust, and a culture where identification and investigation of errors generally promotes

discussion rather than blame.16 An example of transparency in practice is morbidity and

mortality conferences. Morbidity and mortality conferences can be useful communication tools

to address safety issues, but they need to use a structured method for analyzing cases and need to

connect improvement-related decisions with actions and a timeline.17 Transparency and

communication must lead to actionable responses to reducing future errors.

Solutions for improving communication can include innovation and technology. Health

technology can help with preventing adverse events by improve communication, providing point

of care references, assisting with calculations, performing monitoring functions, facilitating

hand-offs, and providing clinical decision support.18 Although technology can be useful in

improving patient safety and reducing errors, technology use often meets barriers at to

integration. Barriers to integration of electronic patient safety reporting systems include

underreporting and low quality of reports, acceptance and effective use of systems, inadequate

instructions and training, lack of reporter-friendly classification, and lack of time and lack of

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feedback.19 Leaders of health care delivery systems should address these barriers to ensure

smooth transitions and implementation of technology solutions to impact patient safety.

The patient also has a role in patient safety, and should be considered to be part of the

patient safety team, in addition to administration, health care providers and staff. A patient’s

participation in engagement with safety is influenced by factors such as knowledge, health

condition, beliefs, and experiences, and can be encouraged through professional development of

providers, focusing on patient-centered care, and clearly defining roles of the patient, staff, and

physicians.20 When providers work together with patients and involve patients in the patient

safety process, the patient is able to act as a barrier to medical error, empowered to be their own

advocate.

There are many ways that health care leadership, providers, staff and patients can

promote patient safety to reduce avoidable adverse events. Reliability-seeking organizations can

reduce safety incidents, improve staff perceptions of the organization, and reduce costs by

standardizing processes, promoting checks while avoiding redundancy, equalizing authority,

developing communication skills and promoting teamwork processes.21 Initiatives in these areas

can improve patient safety when developed and implemented systematically across the health

delivery system.

Although patient safety is a critical first step, it does not paint the whole picture of health

care quality. Clinical outcomes, process, patient satisfaction, and cost complete the health care

quality continuum.

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Clinical Outcomes & Process

Clinical quality includes outcomes and process measures. Outcomes measures for quality

are useful because they show whether a desired result in patient care was achieved or not.

Resources for quality improvement are often limited, so a health system needs to prioritize

indicators that will have the greatest expected impact in terms of net health benefits, the number

of people effected in population, current compliance with measure, probability for quality

improvement and effectiveness of quality improvement.22 Outcomes measures achieve these

goals since they show results that directly affect the patient’s health.

Since improving patient health is the goal of a health care system, outcomes measures

may seem to be the most obvious way to measure health care quality. However, using outcomes

measures has challenges and there are many barriers to defining meaningful quality outcome

indicators.

First, determining which outcome measure is appropriate and how it should be defined

warrants serious consideration. A needs assessment should be performed before developing

quality indicators for monitoring, and should include assessment on illness burden, opportunity

for improvement, the connection between improving care and improving health, and gap

assessment for existing indicators.23 If criteria in these categories are not met, then a selected

outcome measure may not be the best indicator of quality patient care.

In addition, outcomes reporting for quality must incorporate an ethical framework to

avoid the selection of unjust or inappropriate measure. This is especially important when quality

data is reported to consumers. An ethical framework should be used to guide development and

implementation of quality reporting for consumers, in order to ensure data legitimacy, integrity

and quality, transparency, informed understanding, equity, privacy and confidentiality,

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collaboration, accountability and evaluation.24 Consumers must be given an appropriate

explanation of context and methodology for quality measures reported to them, or there is a risk

of misrepresenting the care quality of a specified health care entity or entities.

Certain measures may be misrepresented and unfair comparisons between organizations

may occur if quality indicator definitions are not comprehensive. For example, the interpretation

of readmission data depends on whether planned and unplanned readmissions are both included

or not. Planned readmission may, in fact, be an indicator of good care quality, while unplanned

readmissions could be an indicator of surgical or nonsurgical complications.25 If both types of

readmissions are included and this information is distributed to the health care consumer, it may

be impossible to tell which organizations have better quality since data that could indicate both

good quality and bad quality are compounded into one measure.

The error of choosing a measure simply because it is easily measured and collected

should be avoided as well. Instead of simply prioritizing time and cost-effective quality measures

(which can be counterproductive,) health care organizations should look for valid quality

measures are clinically meaningful, transparent, supported by scientific evidence, link process to

health outcomes, consider anticipated benefits and harms, are reported to all appropriate

stakeholders, and balance the time and resources required for data with anticipated benefits of

the metric.26 If a measure is chosen that does not have real meaning for quality, any time and

effort on collecting and reporting that measure will be wasted and add inefficiency to the health

care system. It could also contribute to loss of credibility in the eyes of health care providers

when assessing future quality reporting, even if future reporting is improved in its methodology.

Outcome measures can be a useful tool to measure health care quality, but should be

developed with sound methodology. Hospital governing boards can help to ensure that sound

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quality indicators are chosen. Hospital governing boards are associated with better quality

outcomes when they have a board quality committee, establish strategic quality improvement

goals, are involved in quality agenda-setting, include quality on board meetings, look

benchmarked data, and link senior executive evaluation to quality measures.27 The board can set

the environment in which quality outcome assessment is given the appropriate amount of

thought, attention and time. Other hospital leadership and organizational structure is also

important for the valid development and application of quality outcome monitoring. In general,

the success of a quality improvement program depends on context and organizational cultural

factors including leadership from top management, organizational culture, and data

infrastructure.28 Outcome measures can be very useful to assess health care quality. Process

measures can also be used to assess quality, and can complement and balance quality outcome

reporting.

Process measures are often chosen to assess health care quality since they can be more

straightforward in definition than outcome measures. A process measure simply states how often

a defined process (or piece of a defined process) was completed or not. Choosing a process

measure that indicates quality, collecting accurate data reflective of the process, and determining

how to define the population for which the process measure should be applied are the major

barriers to defining meaningful process measures for quality assessment. Process measures

should always be directly tied to a desired health outcome. In order to ensure accurate

associations between specific processes and outcomes, quality indicator measure selection

should include assessments on the proximity of the outcome to the process, power to detect

differences, the ability to explain or control for confounding factors, and stability of measure

specifications over time.29 The process measure should be closely tied to the desired outcome,

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there must be power in the process to create a positive difference in the desired health outcome,

the process measure must be directly causal of the desired outcome (confounding factors must

not explain the change) and measurement must be possible over time. If these criteria are met,

then the process measure should have a sound definition.

Defining process measures is the first step to developing valid process measures;

However, even if the process measures have been well-defined, data analysis for the defined

process measure still can create barriers and challenges to effectively use process measures for

quality assessment. Information systems can help to monitor and improve performance of health

care providers, but steps should be taken to ensure that data definitions are accurate, that

measurements correlated with quality improvement, and that both process and outcomes

measures are considered.30 Data entry, abstraction, and interpretation must all be systematically

and accurately carried out.

Process measures ae important because they are often the cause (or source of prevention)

of quality outcomes. Incidence of adverse medical events, which are typically tracked by a

hospital’s risk management or quality assurance departments, often result from system failures

such as inadequate communication, inappropriate staffing levels, lack of training, and poor

patient handoff processes.31 If the processes associated with these failures are fixed, quality

outcomes may also be fixed if it is directly correlated with the process.

Process measures include not only data analysis and reporting, but also quality

improvement methodology and quality improvement tools. Quality improvement tools should be

developed through staff engagement, local input, and experience-based design to adequately

interpret and frame the social context of the health care organization, including political systems,

relationship dynamics, language, assumptions, perceptions, and culture.32 These tools are used to

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effect change in a process, and therefore its associated outcome measure. Quality process

improvement tools should be developed within the context of an individual health care

organization, considering the social confines of the organizational structure and leadership.

There are many types of process improvement tools. Surgical process improvement tools,

such as structured communication tools, clinical mapping tools, and error reduction instruments

can help to standardize and coordinate care, can reduce variations in delivery patterns and

outcomes.33 Other tools can be used to reduce variation as well. Six Sigma can be used can be

integrated into an organizations current quality improvement program to reduce error, eliminate

defects and achieve efficiency.34 Reducing variation in a process is essential since variation from

the best pathway of care often indicates error.

Other methods of effecting positive change in quality and process improvement involve

leadership development. Leadership development can improve quality and efficiency when it

results in workforce improvements, enhanced education and training activities, reduce turnover,

and identify specific strategic priorities.35 Educating the staff and providers within a health care

organization is an important part of process improvement within a health care organization.

The process for quality assessment and improvement itself can be a positive change for

quality in a health care organization. For example, a fractal system could be implemented to

organize workers around common goals, link hospital levels, support peer learning, provide

accountability, and encourage local solutions while using existing available resources.36 This

would create new processes and pathways to develop quality improvement tools while not

requiring a huge burden on already finite resources. This is only one of an infinite number of

processes that could be changed with the goal of affecting health care quality. The needs and

context of the health care organization will dictate what type of intervention is needed, so

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process improvement methodology, implementation and monitoring should usually be completed

at the individual hospital or health care organization level.

Process measures are direct, easy to interpret, and sensitive to differences in care quality,

though they do not reflect all aspects of care like outcomes measures, while outcomes measures

include potential inconsistencies with data collection and difficulty of proper risk adjustment are

major disadvantages.37 Interventions to take care of patients with multiple health problems

should address the interrelatedness of comorbidities in lieu of looking for simple solutions which

may be ineffective.38

Each of these quality indicator types have strengths and weaknesses. They are

complimentary in nature and should be used together to assess the overall quality of health

delivery. Process and outcomes are important ways to measure care quality in health care. Patient

satisfaction or patient experience is also a crucial component to the assessment of health care

quality.

Patient Satisfaction

Patient satisfaction is a key indicator of health care quality. It is directly related to the

patient’s experience with the health care system and affects both real and perceived care quality

to the patient. Patient satisfaction has a reciprocal relationship with quality processes and

outcomes. If patient satisfaction is improved, outcomes and processes of care can be improved. If

Outcomes and processes of care are improved, then patient satisfaction may be influenced. For

example, patient satisfaction with service quality and timeliness of care are an independent

predictors of breast cancer survival.39 Likewise, some patient satisfaction measures can be

improved through improvement in quality processes and outcomes.40 Patient satisfaction is

inextricable from other care quality indicators, and is also an important quality indicator itself.

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Patient experience can be influenced by several factors. For example, patient satisfaction

has been predicted by factors such as meeting preoperative expectations, satisfaction with pain

relief, and satisfaction with the overall hospital experience.41 Interactions with nursing can also

influence patient satisfaction. In fact, nurse job satisfaction can improve the perception of quality

of care by patients.42 All interactions that a patient experiences in the health context may affect

their reported satisfaction. Patient satisfaction can even be influenced after discharged through

processes of follow-up care. For example, proactive telephone follow-up by staff has been an

effective method to enhance quality and patient perception of care, resulting in higher patient

satisfaction and early identification of side effects.43

Assessment on variables that influence patient satisfaction, such as patient expectations,

can be completed through patient satisfaction surveying.44 Surveying can ask patients directly

about their self-reported experiences with the health system. The data can then be aggregated and

analyzed for trends, ultimately pointing to opportunities for quality improvement.

Patient satisfaction is an important indicator of health care quality and can be measured

through surveys that allow patients to self-report their experiences. Patient satisfaction can be

influenced and enhanced by many approaches to patient care, and can be especially influenced

by an approach of shared decision-making.

Shared decision-making is a process that can directly affect the quality of patient care

through enhancing patient engagement. This occurs via an established collaborative relationship

between the physician and the patient. There are three essential elements of shared decision-

making: recognizing the need for a decision, understanding the best evidence, and incorporating

the patient’ values and preferences.45 The physician and patient must both accept and recognize

that a decision needs to be made, discuss and create a mutual understanding about the patient’s

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values, discuss evidence that could possibly affect the decision, and then incorporating the

patient’s values into the possibilities to land on a choice that is the best for the patient given their

particular values and circumstances.

Shared decision-making can be facilitated through validated tools that help both the

patient and physician communicate about treatment options and values. Standardized decision

aids, such as written materials, videos and interactive electronic presentations, can help patients

clarify their values, determine how those values relate to decision, analyze information about

treatment options, and weigh risks as well versus the likelihood of achieving their treatment

goal.46 These types of decision tools should be used when they can help to facilitate

communication between the physician and the patient.

Shared decision-making can have a positive impact on care quality and patient

satisfaction. However, sharing responsibilities of decision-making should follow a logic of care

rather than a logic of choice, since a logic of choice may impose a burden on some patients.47

Shared decision-making is for both parties (physician and patient) to come together to agree on a

process for decision-making that works for them within their individual context. This will help to

ensure that shared decision-making is consistent with the values of patient-centered care.

Patient-centered care puts the values and needs of the patient at the center of focus for

health care decision-making. It includes elements of governance priority, culture of continuous

improvement, IT best practices, evidence protocols, optimized resource use, integrated care,

shared decision-making, targeted services, embedded safeguards, and internal transparency.48

Often, patient-centered care is carried out through a medical home model. A patient centered

medical home model can help with the development of long-term relationships between

physician and patient and care coordination.49 Approaches of shared decision-making and

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patient-centered care can help to ensure that patients are heard and that their satisfaction is

prioritized.

In to shared decision-making at the patient level, community shared-decision making can

help to improve quality at the community level. It can help to engage local consumers on health

care decision-making early and consistently for perspective on governance decision-making,

program design and implementation, and information dissemination.50 If members of the

community are involved in health care governance, a foundation of shared decision-making can

be established for all patients, where the needs of patients and the community are incorporated

both at the policy level and the individual patient level.

The last major component of health care quality assessment is cost.

Cost

The cost of health care is important to health care quality because it is part of the

equation for health care value. Health care resources are, by nature, finite and prioritization

based on ethical analysis and value calculations are essential to ensure that resource allocation is

not unjust.

The approach to cost savings in health care at the organizational level requires

opportunity analysis and process improvement. Methods that work for an individual health care

organization will be context-specific. Some methods that can be used to achieve quality-based

savings are effective data system and management structures, regular feedback based on data,

change oversight, risk adjustment, incentive alignment and using local clinical teams.51 For cost

analysis, in addition to care quality analysis, patient risk must be considered before interventions

can be developed based on raw data. A stratified approach based on patient risk can be helpful to

avoid undesirable outcomes, patient experience and cost measures.52 Distribution of data related

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to cost and other quality measures should also be stratified or adjusted for risk to avoid

misleading data presentation.

Consumers of health care want to see data on cost and quality. Consumers want to see

quality data on physician level and cost data for personal out-of-pocket expense, so there is a

need to pull together data sources for integrated, timely, and relevant consumer health care

reporting. 53 Determining a methodology for putting together these key measures would create a

relatively comprehensive consumer reporting system for health care. Cost and quality reported

together represent value of health care.

Most importantly, health care organizations should facilitate quality through an ethics

lens. Using ethical standards as a foundation for developing quality improvement activities can

help to prevent inadvertently causing harm, wasting resources, or contributing to inequalities.54

Specifically, quality in health care should be approached from a human rights perspective to

ensure that health care delivery is equitable, respect for human vulnerability is maintained and

organizational social responsibility is realized.

3aii Provision of Quality Health Care as a Human Right

The basic right to health and health care that fall into three domains: the basic moral

domain, the legally enforceable political domain, and the international domain (or domain of

relations between different political societies.)55 These three domains – individual/moral,

political/legal, and global – generally provide the existing framework for human rights and

health discourse. This framework lacks crucial domain in health and human rights discourse,

however: the organizational domain. The organizational domain exists as a layer between the

basic moral domain and the political domain, and is an essential missing piece to this framework.

The health care organization is the functional domain is where the right to health is carried out.

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Human rights are carried out in the organizational domain through the function of health care

quality.

Human Right to Quality Care

The right to health should be understood as the right to health care due to its role in

protecting basic human interests.56 Quality health care is essential for humans to thrive and to

realize other rights. This right to quality health care is supported by the United Nations 2030

Agenda for Sustainable Development, which outlines a plan to eradicate poverty, eliminate

hunger and ensure that all human beings can fulfil their potential in dignity and equality,

including equitable and universal access to quality health care where no one must be left

behind.57 Health care disparities must be eliminated and all persons must have access to quality

care, regardless of their social position.

The human rights lens on health provides context and understanding for where there are

disparities and injustices, but they need to be taken a step further than understanding to be

operationalized. 58 This is where health care organizations have a duty to carry out the human

right to health through the provision of quality health care for all individuals. The right to health

provides the foundation for why all individuals have the right to quality health care, but it does

not currently specify how this right is to be carried out or applied in context. Although there are

other key factors to enjoying health, quality health care is essential for almost all humans to

realize their highest attainable level of health.

Other important factors are environmental determinants, such as access to clean drinking

water and healthy food. If an individual is not receiving these basic environmental determinants

of health, the health care organization can care for the patient and provide a structure to identify

and assess whether unhealthy environments are experienced by an individual The organization

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can then provide a structure to help coordinate improvements in the patient’s environment,

whether they be community or individual interventions.

Once the right to health is defined, there is a need for detailed policy prescriptions and

accountability.59 This means that the government has a role in oversight and policy that will

support health care organizations in providing equitable, quality health care. Health care

organizations should work with their federal, state and/or local government to ensure that the

right to quality health care is being protected and that accountability for this provision is

adequately expressed. The government will also need to provide support and resources for the

health care organization to provide quality health care, especially in systems where there is one

or more government payment system for health care services. The rights will be enacted through

the organizational structures and processes to improve quality and monitored through

organizational metrics of process measures, outcomes measures, patient satisfaction measures,

and cost.

In terms of reporting, standardization and accountability are also important at both the

government and organizational level. Accountability measurements for human rights should be

standardized to ensure accurate reporting and that definitions do not change over time.60 Health

care organizations should work with governmental regulatory and oversight bodies to develop

and enact reporting to monitor the success of interventions that protect human rights, related to

the provision of quality health care. Standardized reporting is essential for tracking outcomes of

interventions and policies over time. If the reporting metrics are not stable and definitions

change, it will be impossible to see whether interventions had an impact on the desired outcomes

and whether those outcomes are trending in the right direction.

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Health care organizations also have an obligation to human rights based on their

corporate or business characteristics. Like corporations, health care organizations have social

responsibilities. Corporations have a responsibility to protect, respect and remedy human rights

when they are in the position to do so.61 If non-health care organizations and corporations have

these duties, then health care organizations experience these duties to an even greater extent.

Health care organizations are in a great position to directly remedy human rights, namely the

right to the highest attainable level of health.

Likewise, multinational enterprises have a duty to protect human rights.62 Although

health care organizations are not usually multinational, they have a duty to protect rights within

their own country, just like a multinational enterprise has the duty to protect rights across all of

the countries they have business encounters in. Health care is a service industry but is also a

business, and has parallel obligations of business. However, health care organizations also have

duties that expand upon those of a business since they are commonly mission-driven with

established organizational values. In addition, the social nature of the health care organization,

and its place in the social structure of the community in which it operates gives it special duties

on top of what other for-profit organizations or corporations may have.

If corporations and multinational enterprises have an obligation to protect human rights,

then so do health care organizations. In fact, health care organizations have more of an obligation

than a non-service oriented corporation since their explicit mission is to improve the health of the

individuals and population they serve. A health care organization’s duties are inextricably tied to

their mission and reason for being, which is to promote and protect health. Naturally, this points

the health care organization into the position where protecting the right to health is within the

organizational purview, and should be tied to the organizational mission.

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Human rights related to health give a method of analysis and framework for action to

shape specific intervention, including applying health and human rights framework to practice.63

Health care organizations should use human rights as a basis for developing interventions to

protect and promote health care quality, thereby reducing disparities in health care and

supporting human dignity.

A human-rights based approach can be applied to all quality improvement phases

including conceptualization, design, implementation, monitoring and evaluation, and can

ultimately help to focus outcomes on disparities and gaps in services provided and opportunities

for greater inclusion.64 Human rights should be used as the foundation to improve quality in

health care, and quality in health care should support human rights related to health. The right to

health requires that health care organizations provide quality health care for all individuals.

Ethical Responsibilities of Health Care Organizations

The United Nations Guiding Principles on Business and Human Rights outlines specifics

of the protect, respect and remedy framework that can be used to define duties and

responsibilities of governments and health care organizations. The protect, respect, and remedy

framework is a principles-based conceptual and policy framework aimed at protecting human

rights through state duty to protect against human right abuses, corporate responsibility to respect

human rights, and effective access to remedy human rights violations.65 According to these

principles, states must take appropriate steps to prevent, investigate, punish and redress abuse

through effective policies, legislation, regulations and adjudication; businesses must address

adverse human rights impacts where they are involved, seek to prevent or mitigate adverse

human rights impacts directly linked to their operations, products or services; and there should

be access to remedy where states make appropriate steps to ensure access to effective judicial or

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non-judicial remedy of human rights violations.66 The protect, respect, and remedy framework

offers a starting point for outlining the responsibilities of governments and health care

organizations to protect human rights related to quality health care but these definitions must be

expanded for practical application.

Health care organizations or delivery systems are responsible for creating and sustaining

quality in health care, but the measurement of quality is often dictated or guided by

governmental regulatory programs and payor financial incentives. These can include measures of

outcomes, process, satisfaction or cost. Regulatory policies and financial incentives can support

health care quality, but they can also present barriers to quality if they are poorly designed. For

example, poorly aligned or fragmented financial incentives can impinge on the patient’s

awareness of value or fail to adequately address provider accountability.67 Likewise,

governmental regulatory bodies can fail to support health care quality if they are not well-

designed. The health care organization, therefore, plays a crucial role in facilitating and ensuring

quality patient care processes, outcomes, patient satisfaction and cost. Health care leaders must

follow government and regulatory systems for quality assessment, but must also consider ways

to assess quality on the organizational level.

The World Health Organization’s offers general, broad global standards for government

responsibility and health policies and creates some legal accountability, but is vague in standards

for giving specific mandates to operationalizing rights.68 Health care organizations are the locus

of where these rights will be enacted, and where the power lies to affect change in health care

quality improvement. This gives them the duty to uphold these rights by providing quality health

care for all individuals. International organizations and governments provide some oversight, the

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foundation and groundwork for human rights to be enacted, but are neccesarily implemented at

the organization level.

Part of the governmental duty to protect human rights related to quality health care is

providing universal access, which the United States has yet to achieve. On a national level, the

United States Congress and the Supreme Court have contributed to the evolution inconsistent

framework with an incomplete set of rights, with some but not all rights defined regardless of

ability to pay, including the Emergency Medical Treatment and Active Labor Act (EMTALA),

Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Patient Protection

and Affordable Care Act (ACA.)69 When a government body has a piecemeal approach to the

provision of health care without universal access, it is not supporting optimal provision of quality

health care and thus not supporting the human right to quality health care. To clarify universal

access, a specific, basic minimum of care should be defined to prioritize efficiency, comparative

effectiveness, cost-effectiveness, contextual factors (including the value of hope and the increase

in value we see in life when reference points change,) and underlying common values.70

Government bodies should consciously work toward defining and achieving a basic minimum

threshold for health care services provided, as well as care quality criteria in the categories of

process, outcomes, patient satisfaction and cost.

States can help to support this mission where health care organizations fail. Federally

supported health centers can help to address health care disparities and barriers to meaningful

health care access in underserved communities by providing comprehensive preventative

primary care, focusing on vulnerable populations, encouraging consumer participation, providing

enabling services, cultural and linguistic sensitivity, community partnership, and continuous

quality improvement.71 States have obligations to human rights and health, but the provision of

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quality in health care is ultimately in the control of health care organizations, giving them the

ultimate responsibility for protecting these rights.

The right to health means the right to the highest attainable standard of health, inclusive

of freedoms and entitlements, requiring that all services, goods and facilities must be free from

discrimination, available, accessible, acceptable and of good quality.72 The right to quality health

care without discrimination is an essential part of these inclusions. Based on the provision of

quality health care is a human right, both governments and health care organizations have

obligations to protect this right and mitigate disparities in health among the populations they

serve.

The intention of the UN “protect, respect remedy” framework is to give guidance for

corporate behavior related to human rights and can be used to close gaps between perceptions of

justice within social institutions, given that culture and morals not universal and there may be

competing perceptions of justice within an institution.73 Human rights provides a language for

health care organizations to find a common definition of ethical management and practice.

Human rights discourse is used to create a common moral value, vocabulary and framework for

accountability.74 In this way, health care organizations can use human rights as the foundation to

ensure that quality health care is accessible to all. This will include outcome, process, patient

satisfaction and cost of health care. Based on human dignity, individuals have the rights to

achieve the highest obtainable level of health. As described, this can be measured through

process and outcomes measures and also reflected in satisfaction with health and health care. In

addition, cost can be incorporated into quality assessment since it directly reflects upon value

experienced in health care and in a broader sense relates to health care priority setting.

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The corporate responsibility to protect human rights is especially relevant for health care

organizations based on their inextricable relationship with protecting and promoting human

rights, specifically the right to health. Corporations are social institutions, and health care

organizations have unique social responsibilities since they provide essential services for social

well-being.75 The mission of health care organizations as providers of a social good give them

the responsibility to respect and promote that social good. They must do this by setting and

achieving standards of the human right to quality health care.

Standards of human rights are based on the common value of dignity and equality of

human beings.76 Specific health-related human rights should be operationalized by health care

organizations and should focus carrying out the provision of quality health care for all

individuals. Specific standards for how to provide quality health care should be defined. These

standards should be measured through quality reporting and measurement, including process,

outcome, and patient satisfaction metrics. Cost should also be considered due to its potential

impact on population health.

Human dignity is the basis for developing standards that protect the human right to

quality health care and human rights support and protect the absolute human inner value of

dignity, which is present by virtue of being human and is what calls for certain universal rights.77

Health care organizations have an obligation to protect this dignity, as dictated by the

foundations laid by health and human rights discourse. Standards should specifically be included

in all of the buckets of quality, including process, outcomes, satisfaction, and cost, and should be

refined on the individual organizational level to ensure the ability to implement these standards

at the local level. This means that the outcomes for human rights may be uniform for all

hospitals, but the processes and structures to achieve those outcomes may differ. The scope of

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human rights obligations for corporations should be defined, rather than relying on due diligence,

which gives leeway in moral commitment.78 In addition, respect for human rights at the

organizational level should be monitored by the state government. Although there is a need for a

common set of standards to measure the respect for human rights by corporations, this standard

has yet to be created.79 Nonetheless, organizations should be proactive in respecting and

promoting human rights within their organizations. Approaches to achieve suitable standards for

the protection of human rights can include physician engagement, communication strategies, and

integration with hospital governance.

Physician leaders should be engaged to ensure health care quality. Four critical

components should be considered when engaging with physicians: choosing the right physician

leader, providing access to relevant quality and cost data that physicians trust, utilizing evidence-

based care guidelines, and creating culture of individual accountability.80 These four components

can help to achieve goals of the human right to quality health care.

Communication strategies can also be used to promote the right to quality health care

within a health care organization. Organizations can improve communication strategies including

interventions that are message-based, training-based, technology-driven, community-driven, and

policy-driven, activist interventions.81 These approaches can be used to effectively communicate

with patients and internally within the health care organization in order to support the provision

of quality health care.

Hospital governance also plays an important role in the protection and promotion of

human rights within the health care organization. The role of hospital governance is to enact

social responsibility through a shared vision of common, promotion of shared values and

common ethical standards to create organization value.82 Founded in human rights, this can be an

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effective way to promote care quality and reduce disparities for populations served by the

organization.

Health care governance has a unique role to play in the protection of human rights within

its organization. Differentiations between governance, management and clinical can be defined

as follows: clinical governance encompasses the structures, systems and standards that create

culture and control clinical activities, and create clinical accountability; clinical management

encompasses processes and procedures to promote efficient, effective and systematic high-

quality, safe care; and clinical practice is the direct delivery of quality health care by

physicians.83 The role of governance is to oversee the management and clinical practice at its

institution and to set the environment and expectations for the protection of human rights. They

can create actionable assessments of quality within their organization to ensure the provision of

quality care in terms of outcomes, process, patient satisfaction and cost. When creating these

assessments, health care governance and executive leadership should consider factors of

physician variability, including organizational factors and physician practice patterns.84 When

systematically performed, these assessments can help to facilitate the provision of high-quality

care.

Underlying determinants of health and associated obligations should be defined and

prioritized based on both technical and underlying values of that patients that could influence

their choices about health care, with consideration for both private morality and public policy

needs based on equity for those who need services the most, based on the seriousness of their

condition.85 The health care organization will need to balance the needs and rights of the

individuals they serve and the populations they serve as a whole. A combination of these two

approaches will be the best way to address disparities based on social determinates of health

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while protecting and supporting the human right to quality health care. In order to mitigate the

interactive, multiple risks that affect health care quality within vulnerable populations, a

multifaceted approach should be applied through both policy and health care organizational

approaches.86 Through both policy and organizational approaches, the right to quality health care

can be protected and promoted.

Quality health care is a human right. In general, human rights discourse has a growing

awareness of its relevance to health, including considerations for its associated complex ethical

and legal dimensions such as cultural relevance, regional priorities, individual versus

communitarian values, equality of access, resource allocation, and priority setting.87 Though this

discourse is an important first step to integrating health and human rights, explaining health as a

human right lacks an important degree of precision. This discourse should instead be framed in

terms of quality health care as a human right, which both encompasses and more adequately

defines obligations to protect the right to health.

Human rights are based on the dignity of the human being. Since all humans have

intrinsic dignity, all humans deserve the same rights regardless of any social category in which

they identify with, including but not limited to race, ethnicity, socioeconomic status, age, and

gender. Human rights based on the nature of human dignity requires the elimination of health

disparities related to these categories.

Health care quality can be defined through clinical quality, including process and

outcome measures, patient satisfaction, and cost. The emergence of health as a human right

requires that health care organizations eliminate disparities related to these measures through

provision of health care quality to all individuals.

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3b Organizational Responsibility for Health Care Quality

An organization’s responsibility to protecting the right to quality care is based on its

moral agency. The moral agency of health care delivery organizations bestows responsibilities

upon them to protect the human right to health. This is clarified by the mission and values of

health care organizations. Organizational obligations to health and human rights include the

promotion of quality care and the protection of patient safety.

3bi Organizational Moral Agency

Organizations have ethical obligations through their moral agency.88 The organization’s

moral agency is defined by their mission and values, and is carried out by agents acting upon

their behalf. These agents navigate the ethical environment of the organization using professional

and clinical ethics principles.

The organization’s moral agency is based on its moral identity. Health care organizations

are unique from other types of organizations based on the special goods and services that they

provide. The healthcare organization’s mission and vision should bear this in mind and address

the special stakeholders that healthcare enlists. This can be laid out in the organization’s mission

and values, which serves as the foundation for an organization’s moral identity.

Organizational Identity and Moral Authority

The healthcare organization’s agents embody and act out its moral identity. The moral

identity encompasses the organization’s mission and values, but mission statements are only

words until they are acted upon. Agents of a health care organization can use professional ethics

and clinical ethics in conjunction with the organization’s moral identity to enact the moral

identity of the organization.

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The moral identity of an organization is needed for practical purposes, although it is only

an analogy or metaphor at its core.89 The organization’s moral identity must be operationalized

to enact meaningful moral agency, and how an organization’s mission statement is

operationalized is key to its impact.90 An organization enacts its mission and vision through

agents who act on their behalf. In health care this can range from executive leadership to front-

line staff. When an agent is confronted with specific ethical dilemmas that are not explicitly

covered by the organization’s mission statement and values, they can rely on professional and

clinical ethics to guide their decision-making, ensuring that they are still facilitating the

organization’s moral identity and agency.

Organizational ethics relies on the actions of agents working on the organization’s behalf,

including individuals, and institutional boards and committees.91 The organization’s moral

agency is enacted by the aggregate of its agent’s actions. The agents have their own moral

identity, but when acting on behalf of the organizational moral agency, they must follow the

organization’s mission and values. The organization can be seen as a community, with the moral

identity of the organization and the moral identity of its agents as entwined. 92 The community

values guide the overall actions of the agents, and the aggregate moral identity of the individuals

within the organizational community influence the moral identity of the organization as a whole.

The agent can experience ethical conflict when their own moral identity and that of the

organization clash. Ethical conflict can be caused by the varying pressures of health care

leadership, including those of environmental factors, financial incentives, board of directors, and

stakeholders.93 When an agent of a healthcare organization faces this type of conflict, they can

rely on professional and clinical ethics to mediate.

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A professional is a group of individuals with important and exclusive expertise, internal

and external recognition, and autonomy in matters of expert practice, and specific ethical

obligations or codes.94 A physician is an example of a professional. Individuals can have

multiple roles within an organization and their role-defined obligations have the potential to

conflict, such as when a physician’s role as professional clashes with their role expectations as

employee. Professionals are expected to abide by code of ethics and this code should override

other considerations if a conflict arises, even if commitments to the organization conflict with the

professional role. 95 A physician acting upon the moral agency and identity of an organization

may face a conflict of personal versus organizational values, and in this case, they can rely on

professional codes of ethics to override personal and organizational ethical codes.

Professional ethics is especially important because the tensions that can arise between

self-interest and service to patients can undermine a physician’s credibility.96 Because the

physician-patient relationship is of utmost importance, professional ethics helps to protect the

trust between the physician and the patient. The physician has responsibilities to several

individuals and groups, but the patient is their first and foremost priority and they are bound by

professional ethics put the interest of their patient first at all times.

According to the American Medical Association, the physician has ethical

responsibilities to society, other health professionals, and to self but her first and foremost

responsibility is to her patients.97 This means that if a physician’s role as a professional requires

that she acts a certain way, while her employer mandates that she does the opposite, the

physician is morally obligated to follow her professional code of ethics rather than the

organization’s ethical code. The organization should preemptively attempt to avoid such

conflicts and put the patient at the center of their mission and values.

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Physicians are not the only professionals that practice in health care. Nurses and other

providers are part of professional groups as well. Like physicians, nurses have a professional

ethics codes, although the nurse not traditionally had the level of autonomy or control as

physician, and have typically been employees of physicians or hospitals with a supportive role.98

Nurses face similar issues to physicians when facing conflicting roles within the organization.

Like physicians, they are expected to take their commitment to patient advocacy as their primary

duty, with obligations to the organization as secondary.

It benefits health care organizations to support professional codes because of the crucial

role they play in the physician-patient relationship. As a professional, the physician takes the role

of an advocate, which is important because patients want a physician they can trust to advocate

for their individual interests.99 Maintaining this physician-patient relationship is an important

part of quality care, which should be the highest priority for health care organizations. Health

care organizations should find a way to placate these conflicts within their organizational policy.

Clinical ethics can also help to mediate the role between the organization and its employees.

Clinical ethics addresses issues that arise from the care of patients and considers the

rights of patients as its primary concern, prioritizing patient’s personal autonomy.100 Clinical

ethics is like professional ethics insofar that it puts the patient as the highest priority, but it is

different in that professional ethics looks to the professional code as the highest authority, while

clinical ethics considers patient autonomy to be the highest authority. Clinical ethics typically

focuses attention on particular and individual cases, considering issues such as who should be

involved in decision-making and who is most affected by a decision.101 According to clinical

ethics, the patient choice is considered to be most important in this decision-making process.

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When there is a conflict between what is best for the overall patient population that the

organization serves versus professional obligations in specific cases, clinical ethics can mediate a

solution, such as in the case of clinical futility.102 For example, if a patient is on a ventilator and

is receiving no benefit, the ventilator use could be considered futile care and there may be a

question of whether its support should be withdrawn. The physician may have her own opinions

about what is best for the patient and organizational leadership may have a conflicting stance on

the best course of action. In this case, clinical ethics principles can be applied to help the patient

(or their surrogate) come to a decision about how to proceed. Clinical ethics can be the mediator

when professional and organizational ethics collide, favoring individual choice and clinical

context.

The United States is a pluralistic society of people different values, where no one specific

group has a special claim to morality.103 Clinical ethics recognizes this fact and places the final

decision on the individual patient’s wishes. Ideally, organizational policy is also formed to

respect the differing values and beliefs of patients that a health care organization serves.

Organizational policy should be formed to prevent ethical problems from occurring,

rather than relying on reactive responses as ethical problems arise.104 Although clinical ethics is a

useful tool to mediate unforeseen issues, an organization should attempt to preemptively prevent

these problems from occurring through policy based on their mission and values. Organizations

should also consider clinical ethics in their policy formation because of the potential of conflicts

with clinical issues. Organizational policies can cause questions of clinical ethics when they have

been made or changed without consideration for clinical impact on individuals.105 Organizations

must consider the influence of their high-level decisions on day-to-day operations.

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In sum, organizational moral identity, professional ethics, and clinical ethics are all

important for quality of patient care and should work together to achieve the highest standards

for the patients. On all of these levels, there is moral obligation to address inherent inequalities

that can affect the way patients seek and receive care. Because not all patients enter health care

services with the same needs, organizations are not obligated to provide the same level of

services. The structural inequalities that influence and create social determinants of health should

be considered when determining patient care needs.

Organizational Mission, Vision and Values

There are no absolute requirements for a health care organization’s mission statement,

but in general, it should relay its major commitment to patient care and overall health status of

communities, maintaining public confidence, and providing fair and equitable treatment to

employees.106 When developing its mission statement, the organization can follow criteria such

as alignment with external directives, academic commitments to education and research, clinical

impact, community needs, external partnerships, internal interdependency, and resource

implications.107 Whatever content that the healthcare organization decides to include in its

mission statement, the benefit of its primary stakeholders, namely its patients, should be at its

core.

The organization can follow several steps to ensure that the mission statement

effectiveness is maximized: the organization should involve employees from every level of

hierarchy in the organization during its development; the mission statement should be clearly

communicated; measurable operational targets should be established based on the mission

statement; and the mission statement should be periodically revised to ensure that it remains

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current.108 These steps will help the organization to ensure employee engagement with the

mission statement.

A health care organization’s mission statement can aid in performance improvement by

clearly defining what the organization is trying to achieve.109 Importantly, it should not be

diluted with corporate buzzwords and politically correct terminology, and instead should show

how concepts can be practically applied, and should reflect the organization's true identity.110

The organization’s mission will be the guide for how its moral identity will be enacted by the

organization’s leadership and other agents. The organizational values are also an important piece

of the organization’s moral identity.

The healthcare organization’s values represent what is most important to the organization

and is part of its moral identity. It is important that the organization maintains values that

facilitate trust between the organization and patients. A trust relationship between the patient and

the healthcare organization is essential for the health and financial well-being of patients, the

management of limited resources, and the physician-patient relationship.111 Clearly expressing

organizational values will help to facilitate this trust. Values help the organization to maintain

integrity by establishing commitments, integrating these commitments into daily operations, and

planning for scenarios where organizational values may face conflict.112 Organizational values,

therefore, create the foundation for the relationship between the patient and the healthcare

organization.

It is important for organizations to communicate values that are meaningful. An

organization's established mission and values should not be diluted with corporate buzzwords

and politically correct terminology, and instead should show concepts that can be practically

applied, and should reflect the organization's identity.113 This will help the organization to

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operationalize its mission and values. How an organization’s mission and values are

operationalized is essential to their effectiveness. Healthcare managers can incorporate an

organization's values into daily operations by recognizing the value system at work, determining

what is within their own sphere of influence, incorporating values of internal stakeholders, and

committing to the established organizational values system.114 This approach will systematically

incorporate the organization’s values into everyday actions and tasks.

In addition, the organization’s values can help to define what it considers to be essential

versus non-essential care. It can also be difficult to parse out genuine patient needs versus

preferences, and when a preference becomes strong enough to become a need.115 This question

involves values and its answer depends on who is making the judgment. If the organization

clearly defines its values, these judgements can be preemptively addressed, at least to some

degree.

The moral identity of an organization explains what an organization is, not merely what it

does, and provides framework for the behavior of individual agents working on behalf of the

organization. The agents of an organization carry out the organization’s moral identity. The

actions of the organization’s agents then reflect upon the moral identity of the organization,

meaning that the organization’s moral identity and the actions of its agents are reciprocal.116 The

organization’s moral identity, as defined by its mission and values, will need to be translated into

actions made on behalf of the organization. The actions of the organization’s agents and the

ethical framework in which they work is imperative to upholding the organization’s moral

identity.

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3bii Organizational Obligations to Health Care Quality and Patient Safety

Quality, patient safety, and medical error are closely related. Medical error is a subset of

patient safety, which is a subset of quality care. Organizational systems can and should address

structures of inequality can influence quality/patient safety. Although there are regulatory bodies

which attempt to address health care quality and patient safety, an organization’s internal policy

will create more of an impact for patients than these broad programs. These compliance

programs, which focus primarily on regulations, laws, and social norms, are important, but ethics

programs can cover a broader range of issues and have a wider impact on issues directly related

to patient care.117 Organizations face a moral imperative to address quality and patient safety

issues because of the ethical obligations they hold, based on their moral agency.

Quality improvement begins with an organizational focus on its mission, values, goals,

and expectations as demonstrated by organizational leadership and carried out by staff.118 The

organization’s moral identity and agency are key to improving quality and patient safety

outcomes.

Promoting Quality Care

The Institute of Medicine has defined quality outcomes as safe, effective, efficient,

personalized, timely, and equitable.119 Quality is the broad umbrella under which other more

specific measures of care live, such as patient safety and medical error rates. Poor quality can be

caused by the overuse of procedures that do not improve health, underuse of procedures that

could improve health, and misuse of procedures and can be related to issues such as safety,

effectiveness, patient-centeredness, timeliness, efficiency and equity.120 Quality is part of the

health care value equation which is quality over cost. Because health care faces finite resources,

quality must always be measured against cost. Cost in this case can be thought of as purely

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financial compensation for services and goods, although purely financial costs are not the only

consideration.

Due to the nature of health care, resources are not unlimited. Among many examples of

this include: a limited number of doctors or nurses, a limited number organs for transplant, a

limited amount of blood products, a limited amount of dialysis machines, and a limited number

of hospital beds. These are far from the only examples of limited health care resources and health

care leaders often need to make decisions on how to allocate them in the most effective, efficient,

and fair way. Organizational ethics can guide health care leaders to make these types of

decisions.

The cost of these resources is one of the prevailing issues that health care leaders must

address. Because of this, cost-containment is a prevailing challenge for health care organizations.

There are reoccurring ethical tensions when determining how to balance and prioritize cost and

quality, taking resource constraints and in market competition into consideration.121 Looking for

a new approach to cost-containment, health care regulators, payers, and organizations themselves

have started to look at ways to improve quality of care to reduce unnecessary costs to the system.

In today’s health care environment, organizations must continuously maintain or improve quality

of services while holding down rate of cost growth, focusing on improving processes and/or

outcomes.122 Although the primary goal of a health care organization is first to take care of

patients, this goal cannot be met if it does not remain financially viable. In other words, if a

health care organization does not make a profit, it cannot pursue the mission for the organization.

Weighing the priorities of profit and patient care is at the crux of many ethical dilemmas in

health care.

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Clearly defining goals will help to ensure that decisions are aligned with the

organization’s values. The organization’s goals are not goals of any one individual working for

the organization, but those of the organization as a whole, reflecting the organization’s moral

agency. There will always be ethical questions that arise from unforeseen circumstances, but

organizational policy should attempt to address the organization’s approach to as many of these

possible quandaries as possible to ensure that decisions are made that are consistent with the

organization’s values. Specifically, quality and patient safety goals should be articulated to

address structural issues, reduce inefficiencies in process and improve patient outcomes.123

Quality can be approached through process improvement or monitoring outcomes

measures. Process improvement and outcomes are closely related, and it is often advisable to

address both process and outcomes. Using process measures is advantageous because they tend

to be specific and actionable, addressing the “how” of health care quality improvement.

Outcomes measures show whether the process measures are working to achieve actual improved

patient care, addressing the “why” of health care quality improvement. For example, an outcome

goal could be to reduce infection rates by 10%. The corresponding process goal would be to

increase hand washing by installing hand sanitizer dispensers in each inpatient room. A

successful QI program always incorporates an emphasis on systems and processes, a focus on

patients, a team approach, and meaningful use of data.124

In addition to improved clinical processes and outcomes, patient satisfaction should also

be considered as part of quality improvement. Patient satisfaction is important because patients

who are more satisfied have better compliance with treatment, communicate relevant information

to their provider, are more likely to return for follow up, and experience better outcomes.125

Some examples of process measures for patient satisfaction would be to ask physicians to make

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eye contact and sit down when talking to patients in the outpatient clinic. An outcome measure

could be patient satisfaction scores as measured by CAHPS (Consumer Assessment of

Healthcare Providers and Services) surveys.126 As with clinical quality outcomes, process and

outcome metrics are important for the measurement of patient satisfaction.

Once quality process improvement interventions have been implemented, process and

outcomes measures must be continuously monitored and valued. Health care organizations and

their agents can use PDSA (plan, do, study, act) cycle, to run small, frequent tests of change for

quality improvement efforts, continuously learning and modifying programs from both

successful and failed tests.127 Monitoring is an important component of quality improvement

since it shows whether an intervention is working and allows for an approach to be revised as

needed.

Problems with quality can arise from variation in services, underuse of services, overuse

of services, misuse of services, and disparities among populations.128 Addressing all of these

facets of quality is important, but at the core of these issues is the structural inequalities that

individuals and populations face. Addressing these structural inequalities is key to quality

improvement. Organizations have an ethical obligation to address these inequalities based on

their ethical responsibilities as demanded by their moral agency. Ethics programs can synergize

with quality programs to help organizations balance their commitments to both consumers and

payers, informing potential areas of conflict between the goals and expectations of consumers,

payers, and organizational values.129 Having clearly articulated organizational values and

mission can help health care organizations deliver the highest standard quality of care.

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Included in health care quality improvement is patient safety. Patient safety is a subset of

quality and its process and outcomes goals should also be aligned with the organizational

mission and values.

Protecting Patient Safety

Patient safety is an important component of health care quality. Patient safety describes

health care delivery that does not cause harm to the patient. Medical error is one way that a

patient can be harmed through medical care. Preventable adverse outcomes can arise from

medical error such as medication errors, communication problems, discharge process, retained

sponges, and missed diagnoses, although these errors do not always result in serious

consequences, and adverse outcomes are not always the result of error.130 A patient safety event

is described when the patient is harmed in a way that was not a part of their normal course of

disease or ailment.

This will include the development of a culture of safety. Developing and maintaining a

culture of safety involves facilitating an environment where professionals feel comfortable

addressing safety issues openly, making safety a management priority, creating a learning

organization, valuing employees, thinking in terms of systems, and considering safety as

everyone’s responsibility.131 Additionally, an organization can adopt a patient-centered model. A

patient-centered model considers patients as decision-makers, participants in their own care, and

evaluators of their care.132 Creating systems that encourage patients to be an active part of their

care and recovery greatly improve outcomes.

In sum, improving and maintaining the highest level of quality care and patient safety are

primary goals of health care organizations. Although organizations can create some policies that

address quality and patient safety issues on the surface, they should also look deeper into the

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structural roots that cause some patients to be higher risk for adverse events and outcomes.

Because structural issues related to social determinants of health are so influential on health

outcomes, they should be a primary concern of any health care quality improvement program.

Further reinforcing this concept is the ethical obligation of health care organizations to address

these issues, based on their moral agency and duty to protect human rights. Human rights forms

the ethical foundation for addressing structural inequalities with the goal of improving and

maintaining patient safety and quality of care.

By definition, human rights must be natural, equal, and universal and must apply to every

human simply because of their status as a human.133 Because organizations have moral agency,

they have an ethical obligation to provide safe, high quality care based on respect for the human

rights of the patients they serve. The right to safe, high quality healthcare is explained by the key

human rights principles of respect for human vulnerability and personal integrity, social

responsibility, and health equity.

Organizational values should emphasize the human rights principle of respect for human

vulnerability and personal integrity. Ethical excellence includes commitment to care for

vulnerable populations, such as those without insurance, those with serious illness, the disabled,

the poor, those who do not speak English, those with mental illness, and the very young.134 In

most cases, these special groups face structural barriers to health care that affect their quality and

patient safety outcomes. This can be due to numerous special problems of the vulnerable, such as

psychological barriers, lack access to appropriate care at the appropriate time, and barriers to

getting treatment such as nature and severity of illness.135

Social conditions can alleviate, exacerbate, or even cause these vulnerabilities.

Vulnerability represents the finitude and fragility of life, and describes contexts in which a

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person is incapable of protecting his or her own interests due to insufficient power, intelligence,

education, resources, and/or strength.136 Vulnerability is inherent to life and can be used to

describe all humans, making it a key tenant of human rights. All humans may, at some point in

their life, face circumstances which render them vulnerable as individuals, families, groups,

communities or populations, including disease, disability, personal conditions, environmental

conditions, and/or limited resources.137 These circumstances can be experienced in different

ways, for different durations, and at different times in people’s lives. Not all vulnerabilities are

experienced to the same degree or have the same amount of influence on different people’s lives.

Whileallofhumankindisvulnerableaspartofthehumancondition,certain

individuals,groupsandsituationshave“specialvulnerability”determinedbynaturalor

socialdeterminants,leadingtoincreasedriskstofreedom,autonomy,integrityandgeneral

welfarecausedbysocialexclusion.138Structuralinequalitiesfacilitatetheserisks,including

riskforexploitation,neglectandabuse.Specialvulnerabilitycanbepreventedby

addressingitscontextsandcauses,andtherebyfosteringequalrights,humandignity,and

personalintegrity.139Thecontextsandcauseofmanyofthesevulnerabilitiesaresocial

determinantsofhealthcausedbystructuralinequalitiesinherenttothesocialsystems

peoplelivein.

Theprotectionofpersonalintegritystemsfromthepreventionofvulnerability.As

withvulnerability,protectionforpersonalintegrityisalsomoreurgentforsomegroups

andindividualsthanothers.Somepersonsandpopulationsarealsoneedspecialprotection

forpersonalintegrity.140Healthcareorganizationshaveaspecialobligationtocarefor

thoseinneedofthisprotection.Healthcareorganizationshaveanobligationtorespect

thesenegativerightsandfacilitatethesepositiverightsinsupportofthishumanrights

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principle.Thisisespeciallytruebecausevulnerabilityiscausedorexacerbatedincertain

contextsandsituationsinhealthcare,suchasaccesstohealthcare,provisionofappropriate

healthcare,inequalityofpowerinhealthcare,“doublestandard”research,equivocal

donations,inappropriateresearch,socialvulnerability,vulnerabilityasaresultoflackof

research,stigmatization,unfairpressure,prematureapplicationsoftechnology,genetic

informationandpatientprivacy,unexpectedrisks,andunconsentedcollectionofgenetic

data.141

Becausehealthcareisaspecialtypeofservicethattendstoskewinfavorofthe

sociallyprivileged,healthcareorganizationsshouldtakespecialprecautiontoensurethat

thesevulnerablepopulationsareprotected.Vulnerableindividualsandpopulationsare

worthyofspecialprotectionsbecauseoftheirrelativeorabsoluteincapabilitytoprotect

theirowninterestsbasedoninsufficientpower,intelligence,education,resources,

strength,orothernecessaryattributestoprotectoneselffromabuseorexploitation.142An

individualorpopulationcanbeespeciallyvulnerableformanyreasons,anditisimportant

torecognizethestructureswhichcausethesevulnerabilities,aswellasthewaysinwhich

thevulnerabilitiesmanifestthemselvesinordertoreducetheirnegativeimpacts.

Vulnerabilityisuniversal,andallpeoplearevulnerableatsomepointintheirlife.

Althoughallpeoplefacevulnerability,someexperiencetransientvulnerabilitydueto

temporarycircumstances,whileothersexperiencevulnerabilitythatisinherenttothe

politicalsystems,socioeconomiccircumstances,orotherfactorsthatindividuallyor

collectivelyconstraintheircapacityforfreedom.143

Insum,recognizingsystemsthatcreatethesevulnerabilities,whethertransientor

permanent,isanimportantsteptowardmakingmeaningfulpolicytoprotectthese

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individualsandpopulations.Healthcareencompassesuniquegoodsandserviceswhichare

inextricablylinkedtovulnerabilityandhumanintegrity.Inhealthcare,vulnerabilityis

especiallyimportantinthephysician‐patientroutinerelationship,researchsetting,and

biotechnologicaladvances.Theseuniqueaspectsofhealthcareintroducepower

relationshipswhichhavethepotentialforabuseandexploitation.Asahumanrights

imperative,thesevulnerabilitiesshouldberecognizedandaddressed–especiallyforthose

withinherentandspecialvulnerabilities.Healthcareorganizationshaveanethical

obligationtoaddressthesespecialvulnerabilitiesinordertoimprovequalityofcareand

patientsafety.Becausethehealthcareorganizationhasmoralagency,theyareexpectedto

actbasedonethicalmeritsofdecisions.Arespectforhumanrightsshouldbeatthecoreof

thisdecision‐making,includinganendorsementofsocialresponsibility.

Therespectforhumanvulnerabilityhelpstoexplainwhyorganizationshavean

obligationtoaddressstructuralinequalities.Becauseofthisprinciple,organizationshavea

moraldutytoprotectandprioritizevulnerablepopulations,namelythosethatexperience

structuralbarrierstoaccessinghealthcare.

Socialresponsibilityexplainsthathumansshouldconsiderandavoidwaysinwhich

theiractionsmaynegativelyaffectsocialconditions.Inrelationtohealth,social

responsibilityemphasizesasharedcommitmentofallstakeholderstopromoteandprotect

socialconditionsthatinfluencehealthsuchasbirthplace,nationality,andage.144Thehealth

careorganizationhastheresponsibilitytotheirstakeholdersbasedontheirmoralagency

andabilitytoenactethicaldecisions.

Socialresponsibilitydemandspositiveactiontoimprovesocialconditionsofthose

whosufferfromsocially‐constructedvulnerability.Freedomcanbetheoreticallyavailable,

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butitisnoteffectiveunlessitallowspeoplefreedomtoact.Healthcareorganizationsneed

tofacilitateeffective,notjusttheoreticalfreedom.Thiscanincludeengagementinsocial

development.

Socialdevelopmentismulti‐facetedandtakescarefulplanningandconsiderationof

limitedresources.Itinvolvesthedevelopmentofmaterialconditions,formalandcultural

structures,andeducation,andshouldbepartofdeliberategovernmentalpolicy.145The

responsibilityofgovernmentstopromotesocialdevelopmentisofcrucialimportanceto

thehealthofpopulations.Althoughhealthcareorganizationscannotdirectlychangemany

oftheseconditions,recognizingtheimportanceofsocialconditionsandsocialdevelopment

canbethebasisforpreferentialtreatmentforsomegroups.Healthcareservicesarean

importantpartofaperson’ssocialenvironment,andimprovinghealthcanhelpindividuals

achieveinotherareasofsocialdevelopment.Improvinghealthisbothanoutcomeand

prerequisitefordevelopment.146Thehealthofindividualsandpopulationsaffectsabilities

togaineffectivefreedomforeconomicgrowthsuchastheabilitytoholdajoband

educationalopportunities.Inturn,improvedeconomicandsocialconditionsimprove

health.

Althoughsocialresponsibilityisasolidfoundationforsupportingdevelopment,it

canbedifficulttocarryoutinreal‐worldcontexts.Socialresponsibilityrequiresresources

topursuegoalsthatareoftenlimited.Thismeansthatgoalswithinhealthcareandsociety

asawholeneedtobeweighedandprioritizedwithanemphasisonfairnessandbasedin

commonhumanity.147Apersonwhofacesasocialsituationmakingthemmorevulnerable

wouldpossiblywarrantmoreresourcesfromahealthcareorganizationduetogreater

need.Basedonsocialresponsibility,physicianshaveanethicalobligationtospendtime

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addressingthesocialinequalitiesthatadverselyaffecthealth.148Sincethesesocial

conditionscangreatlyaffect,orevencausecertainhealthoutcomes,theywarrantserious

attentionfrommedicalproviders.Physicians,actingasagentsforthehealthcare

organization,canhelptheorganizationtocarryoutsocialresponsibilityinthisway.

The interdependence of social structures and health should always be considered when

making difficult choices of resource allocation. Structural inequalities should be eliminated or at

least minimized when determining allocation of limited or scarce resources. Ethical analysis can

help to prioritize resources when there are competing needs such as health care, building

infrastructure, and education.149 Health care organizations can do their part by improving the

health care system and supporting human rights. Respect for human vulnerability and social

responsibility combine with the principle of health equity to form the basis of a human rights

approach to quality improvement and patient safety.

Equity involves fair, equitable and appropriate treatment of people, so that equals are

treated equally and unequals are treated unequally.150 In health care, this can mean giving the

most resources to individuals who need the most. In this care, equals mean equal need, so those

who have equal need should be given equal treatment, while those who are better off should

receive less treatment and those who are worse off should receive more treatment.

Healthisauniversal,basichumanneedthattypicallydependsoneconomicand

socialstructuresofsocialhierarchythatdistributeresources.151Inajustsystem,this

resourcedistributioniscreatedthroughpatientneed,notthroughabilitytopayorsocial

status.Therighttohealthcareisbasedonequitybecauseitrepresentsfairlydistributed

accesstosocialprotectionandmitigatesunfairopportunityimbalancecausedbyfactors

outsideofaperson’sowncontrol.152Allhumansshouldhaveanequalrighttohealthcare

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basedonequityandfairness.Healthdisparitiesarearesultofsystematicinequalities

betweengroupsbasedonsocialdisadvantage,andshouldbeviewedthroughthelensof

socialjustice.153Ahealthcareorganizationhasanobligationtoaddresssocialinequalities

thatarearesultofunjustsocialsystems.Becauseofitsemphasisonthemitigationof

inequality,justiceincludesmakingapreferentialoptionforthepoor.Thisisbecausethe

poorsuffertheworsthealthoutcomes,producedbystructuralmechanismsofexploitation

andpoverty.154Becauseofthehealthoutcomesthatresultfromstructuralinequalitiesthat

createthisinjustice,healthcareorganizationshaveamoralobligationtoaddressthese

issues.

Alternatively,developmentmayseemlikeausefulapproach,butitislimitedbythe

oppressivesystemsthatitattemptstoworkwithin.Unjustsystemswillonlybeget

injustice,evenifthatinjusticeistemporarilymitigated.Theonlywaytoaddressthese

inequalitiesforlong‐termimprovementsisthroughasocialjusticeapproach.Healthcare

organizationshaveadutytoprovideajustsystemofcareforthepatientpopulationit

serves.Thisdutyisbasedonanequalconcernapproachtohealthcare,whichisfoundedin

asocialobligationtojusticeandhumanrightsratherthanoneofcharity.155Whenhealthis

viewedasahumanrightandasocialjusticeapproachistaken,doublestandardsforthe

richandpoorareerased.Ajustice‐basedapproachaddressestherootoftheproblems

ratherthansimplyfunctioningasastrategyformanaginginequality.Thepreferred

approachforaddressingstructuralinequalitiesindevelopingcountriesisthesocialjustice

model.Thismodellooksatinequalitiesashuman‐madeandaddressesthestructuresthat

createandmaintainpovertyandmakepeoplesick.156Theroleofthehealthcare

organizationistoimprovethehealthofthepatientstheyserve,andaddressingthese

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structuralinequalitieswillbethemosteffectivewaytoachievethisbecausetheyexplain

therootcauseofpooroutcomes.

Povertyisahumanrightsissuethataffectshealthoutcomes.Eradicatingpovertyis

oftenseenasanidealisticandunrealisticgoal.However,basedonprinciplesofhuman

rights,thegoalofcompleteeradicationofpovertyistheonlyonethatisacceptable.Itis

alsoimportanttoavoidself‐fulfillingpropheciesthataredetrimentaltopovertyandhealth.

Humanrightsandhealthadvocatesshouldavoidself‐fulfillingpropheciesrelatedto

poverty,orpredictionsthatinfluenceoutcomes.Predictingthatonewillnotbeableto

influenceasocialenvironmentcanactuallyinfluencetheabilitytoachievethatgoal.

Thegoaloferadicationofpovertyandachievementofthehighestlevelofachievable

healthforallistheonlygoalsupportedbyhumanrights.Similarly,healthcare

organizationsshouldstrivetowardaneradicationofpreventableadversepatientsafety

outcomes.Thepredictionthatanorganizationcaneliminatethesepooroutcomeswillbe

thefirststeptowardachievingthisgoal.Tocarryoutcommitmentstohumanrights,the

structuresofhowhealthcareandthesocialworldarounditmustbeaddressed,including

thedesignandmaintenanceofinstitutionsthatminimizehumanrightsviolations.157

Humanrightsprinciplessupportthedutyofhealthcareorganizationstoaddressstructural

inequalitiesthatcausepoorhealthoutcomes.Moralagencyexplainswhyhealthcare

organizationshaveanethicaldutytoaddresstheseissues.Becausehealthcare

organizationshaveethicalduties,theyareabletohavemoralobligationstoaddressthese

issuesthatresultfromhumanvulnerabilityandarefoundedinsocialresponsibilityand

healthequity.

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Organizational ethics exists within an external and internal moral climate and reflects

how an organization’s performance aligns with expectations set by social norms as well as its

own goals and values.158 An organization’s moral agency describes how the organization enacts

these goals and values. In the case of health care, these goals and values are focused on

providing safe and quality care. Providing safe, quality care requires that organizations address

structural inequalities faced by the patients they serve. The obligations of organizations to

address these structural issues are based on human rights principles, namely respect for human

vulnerability, social responsibility, and equity.

1 Block, Dale J. M. D. C. P. E. "Revisiting the Triple Aim‐Are We Any Closer to Integrated Health Care?" Physician Executive 40, no. 1 (Jan/Feb 2014): 40‐3. 

2 Kim, Linda, Courtney H. Lyder, Donna McNeese‐Smith, Linda Searle Leach, and Jack Needleman. "Defining Attributes of Patient Safety through a Concept Analysis." Journal of Advanced Nursing 71, no. 11 (2015): 2490‐503. 

3 Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system. Washington, D.C.: National Academy Press. (2000): 26. 

4 Committee on Quality Health Care in America, Institute of Medicine. Crossing The Quality Chasm : a New Health System for the 21st Century. Washington, D.C. :National Academy Press (2001): 5‐6 

5 The Joint Commission. “Facts about the National Patient Safety Goals.” Retrieved 1/13/2018. https://www.jointcommission.org/facts_about_the_national_patient_safety_goals/ 

6 The Joint Commission. “2018 National Patient Safety Goals.” Retrieved 1/13/2018. https://www.jointcommission.org/standards_information/npsgs.aspx 

7 National Quality Forum. “Serious Reportable Events.” 2008.http://www.qualityforum.org/topics/sres/serious_reportable_events.aspx 

8 Centers for Medicare and Medicaid Services. “Outcomes.” Retrieved 1/13/2018. https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/HospitalQualityInits/OutcomeMeasures.html 

9 Institute for Healthcare Improvement. “Patient Safety: Overview.” Retrieved 1/13/2018.  http://www.ihi.org/Topics/PatientSafety/Pages/Overview.aspx 

10 Agency for Healthcare Research and Quality. “Tools and Resources.” Retrieved 1/13/2018. https://www.ahrq.gov/professionals/quality‐patient‐safety/patient‐safety‐resources/index.html 

11 Brandis, Susan, Stephanie Schleimer, and John Rice. "Bricks‐and‐Mortar and Patient Safety Culture." Journal of Health Organization and Management 31, no. 4 (2017): 459‐70. 

12 Frader, Joel E., and Charles L. Bosk. "Mistakes, Medical." In Bioethics, edited by Bruce Jennings, 2107‐13. Farmington Hills, MI: Macmillan Reference USA, 2014. 

13 Duffy, William. "Improving Patient Safety by Practicing in a Just Culture." Association of Operating Room Nurses. AORN Journal 106, no. 1 (Jul 2017): 66‐68. 

14 van Melle, Marije A., Dorien L. M. Zwart, Antoinette A. de Bont, Ineke W. M. Mol, Henk F. van Stel, and Niek J. de Wit. "Improving Transitional Patient Safety: Research Protocol of the Transitional Incident Prevention Programme." Safety in Health 1 (2015). 

                                                            

Page 151: An Ethical Framework for Organizational Resource

 

143

                                                                                                                                                                                                15 Birmingham, Patricia, Martha D. Buffum, Mary A. Blegen, and Audrey Lyndon. "Handoffs and Patient Safety: Grasping the Story and Painting a Full Picture." Western Journal of Nursing Research 37, no. 11 (Nov 2015): 1458. 

16 Kachalia, Allen M. D. J. D. "Improving Patient Safety through Transparency." The New England Journal of Medicine 369, no. 18 (2013): 1677‐9. 

17 Bal, Gaëlle, Elodie Sellier, Sandra D. Tchouda, and Patrice Francois. "Improving Quality of Care and Patient Safety through Morbidity and Mortality Conferences." Journal for Healthcare Quality 36, no. 1 (Jan/Feb 2014): 29‐36. 

18 Barton, Amy J. PhD R. N. Faan, and Mary Beth Flynn PhD R. N. C. N. S. Ccns Faan Makic. "Technology and Patient Safety." Clinical Nurse Specialist 29, no. 3 (May/Jun 2015): 129. 

19 Gong, Yang, Song Hsing‐Yi, Xinshuo Wu, and Lei Hua. "Identifying Barriers and Benefits of Patient Safety Event Reporting toward User‐Centered Design." Safety in Health 1 (2015). 

20 Vaismoradi, Mojtaba, Sue Jordan, and Mari Kangasniemi. "Patient Participation in Patient Safety and Nursing Input – a Systematic Review." Journal of Clinical Nursing 24, no. 5‐6 (2015): 627‐39. 

21 Padgett, Jared, Kenneth Gossett, Roger Mayer, Wen‐Wen Chien, and Freda Turner. "Improving Patient Safety through High Reliability Organizations." The Qualitative Report 22, no. 2 (Feb 2017): 410‐25. 

22 Meltzer, David O., and Jeanette W. Chung. "The Population Value of Quality Indicator Reporting: A Framework for Prioritizing Health Care Performance Measures." [In English]. Health Affairs 33, no. 1 (Jan 2014): 132‐9. 

23 Stelfox, Henry T., and Sharon E. Straus. "Measuring Quality of Care: Considering Measurement Frameworks and Needs Assessment to Guide Quality Indicator Development." Journal of Clinical Epidemiology 66, no. 12 (Dec 2013): 1320‐7. 

24 Suchy, Kirsten. "A Lack of Standardization: The Basis for the Ethical Issues Surrounding Quality and Performance Reports." Journal of Healthcare Management 55, no. 4 (Jul/Aug 2010): 241‐51. 

25 McCormack, Richard M. D., Ryan Michels, Nicholas Ramos, Lorraine Hutzler, James D. M. D. Slover, Joseph A. M. D. Bosco, and Arby M. D. Facs Khan. "Thirty‐Day Readmission Rates as a Measure of Quality: Causes of Readmission after Orthopedic Surgeries and Accuracy of Administrative Data/Practitioner Application." Journal of Healthcare Management 58, no. 1 (Jan/Feb 2013): 64‐76; discussion 76‐7. 

26 Saver, Barry G., Stephen A. Martin, Ronald N. Adler, Lucy M. Candib, Konstantinos E. Deligiannidis, Jeremy Golding, Daniel J. Mullin, Michele Roberts, and Stefan Topolski. "Care That Matters: Quality Measurement and Health Care." PLoS Medicine 12, no. 11 (Nov 2015). 

27 Jiang, H. Joanna PhD, Carlin Lockee, Karma Fache Bass, Irene PhD Fraser, and Eric P. Fache Norwood. "Board Oversight of Quality: Any Differences in Process of Care and Mortality?" Journal of Healthcare Management 54, no. 1 (Jan/Feb 2009): 15‐29; discussion 29‐30. 

28 Kaplan, Heather C., Patrick W. Brady, Michele C. Dritz, David K. Hooper, W. Matthew Linam, Craig M. Froehle, and Peter Margolis. "The Influence of Context on Quality Improvement Success in Health Care: A Systematic Review of the Literature." Milbank Quarterly 88, no. 4 (2010): 500‐59. 

29 Parast, Layla, Brian Doyle, Cheryl L. Damberg, Kanaka Shetty, David A. Ganz, Neil S. Wenger, and Paul G. Shekelle. "Challenges in Assessing the Process‐Outcome Link in Practice." Journal of General Internal Medicine 30, no. 3 (Mar 2015): 359‐64. 

30 Pronovost, Peter J., Thomas Nolan, Scott Zeger, Marlene Miller, and Haya Rubin. "How Can Clinicians Measure Safety and Quality in Acute Care?" The Lancet 363, no. 9414 (2004): 1061‐7. 

31 Jones, D. Scott. "Reporting Adverse Medical Events: Quality Reporting Meets Compliance." Journal of Health Care Compliance 14, no. 4 (2012): 53‐76. 

32 Millar, Ross. "Framing Quality Improvement Tools and Techniques in Healthcare." [In English]. Journal of Health Organization and Management 27, no. 2 (2013): 209‐24. 

33 Wei, Alice C., David R. Urbach, Katharine S. Devitt, Meagan Wiebe, Oliver F. Bathe, Robin S. McLeod, Erin D. Kennedy, and Nancy N. Baxter. "Improving Quality through Process Change: A Scoping Review of Process Improvement Tools in Cancer Surgery." BMC Surgery 14 (2014): 45. 

34 Woodard, Tanisha D. "Addressing Variation in Hospital Quality: Is Six Sigma the Answer?" Journal of Healthcare Management 50, no. 4 (Jul/Aug 2005): 226‐36. 

35 McAlearney, Ann Scheck ScD, and Peter W. Butler. "Using Leadership Development Programs to Improve Quality and Efficiency in Healthcare." Journal of Healthcare Management 53, no. 5 (Sep/Oct 2008): 319‐31; discussion 31‐2. 

36 Pronovost, Peter J., and Jill A. Marsteller. "Creating a Fractal‐Based Quality Management Infrastructure." Journal of Health Organization and Management 28, no. 4 (2014): 576‐86. 

Page 152: An Ethical Framework for Organizational Resource

 

144

                                                                                                                                                                                                37 Mt, Joannathan. "Process Versus Outcome Indicators in the Assessment of Quality of Health Care." International Journal for Quality in Health Care 13, no. 6 (2001): 475. 

38 Zulman, Donna M. M. D. M. S., Steven M. M. D. M. P. H. Asch, Susana B. M. D. MSc Martins, Eve A. M. D. M. P. H. Kerr, Brian B. M. D. Hoffman, and Mary K. M. D. M. S. Goldstein. "Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness." Journal of General Internal Medicine 29, no. 3 (Mar 2014): 529‐37. 

39 Gupta, Digant, Mark Rodeghier, and Christopher G. Lis. "Patient Satisfaction with Service Quality as a Predictor of Survival Outcomes in Breast Cancer." Supportive Care in Cancer 22, no. 1 (Jan 2014): 129‐34. 

40 Leicht, Karl‐heinz, Wilfried Honekamp, and Herwig Ostermann. "Quality Management in Professional Medical Practices: Are There Effects on Patient Satisfaction?" [In English]. Journal of Public Health 21, no. 5 (Oct 2013): 465‐71. 

41 Hamilton, D. F., J. V. Lane, P. Gaston, J. T. Patton, D. MacDonald, A. H. R. W. Simpson, and C. R. Howie. "What Determines Patient Satisfaction with Surgery? A Prospective Cohort Study of 4709 Patients Following Total Joint Replacement." BMJ Open 3, no. 4 (2013). 

42 Kvist, Tarja, Ari Voutilainen, Raija Mäntynen, and Katri Vehviläinen‐Julkunen. "The Relationship between Patients' Perceptions of Care Quality and Three Factors: Nursing Staff Job Satisfaction, Organizational Characteristics and Patient Age." BMC Health Services Research 14 (2014): 466. 

43 Boardman, Anne, Joanne Wilkinson, and Ruth Board. "Patient Satisfaction with Telephone Follow up after Treatment." Cancer Nursing Practice (2014+) 14, no. 9 (Nov 2015): 27. 

44 Russell, Roberta S., Dana M. Johnson, and Sheneeta W. White. "Patient Perceptions of Quality: Analyzing Patient Satisfaction Surveys." International Journal of Operations & Production Management 35, no. 8 (2015): 1158‐81. 

45 Légaré, France, and Holly O. Witteman. "Shared Decision Making: Examining Key Elements and Barriers to Adoption into Routine Clinical Practice." [In English]. Health Affairs 32, no. 2 (Feb 2013): 276‐84. 

46 Oshima Lee, Emily M. A., and Ezekiel J. M. D. PhD Emanuel. "Shared Decision Making to Improve Care and Reduce Costs." The New England Journal of Medicine 368, no. 1 (2013 Jan 03): 6‐8. 

47 Olthuis, Gert, Carlo Leget, and Mieke Grypdonck. "Why Shared Decision Making Is Not Good Enough: Lessons from Patients." Journal of Medical Ethics 40, no. 7 (Jul 2014): 493. 

48 Cosgrove, Delos M., Michael Fisher, Patricia Gabow, Gary Gottlieb, George C. Halvorson, Brent C. James, Gary S. Kaplan, et al. "Ten Strategies to Lower Costs, Improve Quality, and Engage Patients: The View from Leading Health System Ceos." Health Affairs 32, no. 2 (Feb 2013): 321‐7. 

49 Ewing, Michael. "The Patient‐Centered Medical Home Solution to the Cost‐Quality Conundrum." Journal of Healthcare Management 58, no. 4 (Jul/Aug 2013): 258‐66. 

50 Mende, Susan, and Deborah Roseman. "The Aligning Forces for Quality Experience: Lessons on Getting Consumers Involved in Health Care Improvements." Health Affairs 32, no. 6 (Jun 2013): 1092‐100. 

51 James, Brent C., and Lucy A. Savitz. "How Intermountain Trimmed Health Care Costs through Robust Quality Improvement Efforts.” Health Affairs 30, no. 6 (Jun 2011): 1185‐91. 

52 Lewis, Geraint, Heather Kirkham, Ian Duncan, and Rhema Vaithianathan. "How Health Systems Could Avert 'Triple Fail' Events That Are Harmful, Are Costly, and Result in Poor Patient Satisfaction." Health Affairs 32, no. 4 (Apr 2013): 669‐76. 

53 Yegian, Jill Mathews, Pam Dardess, Maribeth Shannon, and Kristin L. Carman. "Engaged Patients Will Need Comparative Physician‐Level Quality Data and Information About Their out‐of‐Pocket Costs." [In English]. Health Affairs 32, no. 2 (Feb 2013): 328‐37. 

54 Lynn, Joanne, Mary Ann Baily, Melissa Bottrell, Bruce Jennings, Robert J. Levine, Frank Davidoff, David Casarett, et al. "The Ethics of Using Quality Improvement Methods in Health Care." Review Article. Annals of Internal Medicine 146, no. 9 (2007): 666‐W161. 

55 Eleftheriadis, Pavlos. "A Right to Health Care." 268‐85: Wiley‐Blackwell, 2012. 56 Hessler, Kristen, and Allen Buchanan. "Equality, Democracy and the Human Right to Health Care." In Medicine and Social Justice: Essays on the Distribution of Health Care, Second ed. New York: Oxford University Press, 2012. 97‐104. 

57 General Assembly resolution 70/1, Transforming Our World: The 2030 Agenda for Sustainable Development, A/RES/70/1 (25 September 2015.)  

58 Gruskin, Sofia, Dina Bogecho, and Laura Ferguson. "'Rights‐Based Approaches' to Health Policies and Programs: Articulations, Ambiguities, and Assessment." Journal of Public Health Policy 31, no. 2 (Jul 2010): 129‐45. 

Page 153: An Ethical Framework for Organizational Resource

 

145

                                                                                                                                                                                                59 Bustreo, Flavia, and Paul Hunt. "The Right to Health Is Coming of Age: Evidence of Impact and the Importance of Leadership." Journal of Public Health Policy 34, no. 4 (Nov 2013): 574‐9. 

60 Fariss, Christopher J. "Respect for Human Rights Has Improved over Time: Modeling the Changing Standard of Accountability." The American Political Science Review 108, no. 2 (May 2014): 297‐318. 

61 Dubach, Barbara, and Maria Teresa Machado. "The Importance of Stakeholder Engagement in the Corporate Responsibility to Respect Human Rights." International Review of the Red Cross 94, no. 887 (Sep 2012): 1047‐68. 

62 Shemberg, Andrea. "New Global Standards for Business and Human Rights." Business Law International 13, no. 1 (Jan 2012): 27‐33,1. 

63 Gruskin, Sofia. Perspectives on Health and Human Rights. New York: Routledge, 2005. 3‐49 64 Smith‐Estelle, Allison, Laura Ferguson, and Sofia Gruskin. "Applying Human Rights‐Based Approaches to Public Health: Lessons Learned from Maternal, Newborn and Child Health Programs." Etude de la Population Africaine 29, no. 1 (2015): 1713‐28. 

65 UN Human Rights Council, Protect, respect and remedy : a framework for business and human rights : report of the Special Representative of the Secretary‐General on the Issue of Human Rights and Transnational Corporations and Other Business Enterprises, John Ruggie, 7 April 2008. 

66 Office of the High Commissioner, United Nations. Guiding Principles on Business and Human Rights: Implementing the United Nations "Protect, Respect and Remedy" Framework. New York and Geneva: United Nations, 2011. 

67 Nix, Kathryn A., and John S. O'Shea. "Improving Healthcare Quality in the United States: A New Approach." Southern Medical Journal 108, no. 6 (2015): 359‐63. 

68 Meier, B. M., and W. Onzivu. "The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance." Public Health 128, no. 2 (Feb 2014): 179‐87. 

69 Hamel, Mary Beth, Jennifer Prah Ruger, Theodore W. Ruger, and George J. Annas. "The Elusive Right to Health Care under U.S. Law." The New England Journal of Medicine 372, no. 26 (2015): 2558‐63. 

70 Menzel, Paul T. "Setting Priorities for a Basic Minimum of Accessible Health Care." In Medicine and Social Justice: Essays on the Distribution of Health Care, Second ed. New York: Oxford University Press, 2012. 131‐141. 

71 Shi, Leiyu DrPH M. B. A. M. P. A., Lydie A. PhD M. P. H. Lebrun‐Harris, Charles A. M. H. A. Daly, Ravi PhD Sharma, Alek PhD M. P. H. Sripipatana, A. Seiji M. D. M. P. H. Hayashi, and Quyen M. D. M. P. H. Ngo‐Metzger. "Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers." Journal of Health Care for the Poor and Underserved 24, no. 1 (Feb 2013): 56‐66. 

72 UN Office of the High Commissioner for Human Rights (OHCHR), Fact Sheet No. 31, The Right to Health, June 2008, No. 31 

73 Murphy, Matthew, and Jordi Vives. "Perceptions of Justice and the Human Rights Protect, Respect, and Remedy Framework." Journal of Business Ethics 116, no. 4 (Sep 2013): 781‐97. 

74 Fenton, Elizabeth, and John D. Arras. "Bioethics and Human Rights: Curb Your Enthusiasm." [In English]. Cambridge Quarterly of Healthcare Ethics 19, no. 1 (Jan 2010): 127‐33. 

75 Hall, Robert T. An Introduction to Healthcare Organizational Ethics. Oxford: Oxford University Press, 2000. 41‐56. 76 Dessart, Francis. "Freedom and the Fundamental Right of the Human Being." International Journal of Communication Research 4, no. 3 (Jul‐Sep 2014): 289‐95. 

77 Hernandez, Jill Graper. "Human Value, Dignity, and the Presence of Others." [In English]. HEC Forum 27, no. 3 (Sep 2015): 249‐63. 

78 Fasterling, Björn, and Geert Demuijnck. "Human Rights in the Void? Due Diligence in the Un Guiding Principles on Business and Human Rights." Journal of Business Ethics 116, no. 4 (Sep 2013): 799‐814. 

79 de Felice, Damiano. "Business and Human Rights Indicators to Measure the Corporate Responsibility to Respect: Challenges and Opportunities." Human Rights Quarterly 37, no. 2 (May 2015 2015): 511‐555. 

80 Citrin, Levi J. D., and Richard M. D. Blath. "Critical Management Tools for Getting Costs under Control." Physician Executive 39, no. 6 (Nov/Dec 2013): 28‐31. 

81 Dutta, Mohan J. "Reducing Health Disparities: Communication Interventions." In Reducing Health Disparities: Communication Interventions, edited by Gary L. Kreps, 1‐14. Vol. 6. New York: Peter Lang Publishing, 2013. 

82 Brandão, Cristina, Guilhermina Rego, Ivone Duarte, and Rui Nunes. "Social Responsibility: A New Paradigm of Hospital Governance?". Health Care Analysis 21, no. 4 (2013): 390. 

83 Brennan, Niamh M., and Maureen A. Flynn. "Differentiating Clinical Governance, Clinical Management and Clinical Practice." Clinical Governance 18, no. 2 (2013): 114‐31. 

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                                                                                                                                                                                                84 Sutter, Robert R. N. M. B. A. M. H. A., Brian M. P. H. Waterman, and Michael M. D. Facog Udwin. "An Analytical Approach to Improving Physician Performance." Physician Executive 39, no. 3 (May/Jun 2013): 26‐36. 

85 Yamin, Alicia Ely, and Angela Duger. "Adjudicating Health‐Related Rights: Proposed Considerations for the United Nations Committee on Economic, Social and Cultural Rights, and Other Supra‐National Tribunals." Chicago Journal of International Law 17, no. 1 (Summer 2016): 80‐120. 

86 Shi, Leiyu, and Gregory D. Stevens. Vulnerable Populations in the United States. Second ed. San Francisco, CA: Jossey‐Bass, 2010. 152‐163 

87 Bennett, Belinda. "Introduction: Health and Human Rights." International Journal of Law in Context 7, no. 3 (Sep 2011): 271‐72. 

88 Winkler, Eva C and Russell L. Gruen. Organizational Ethics. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd.  London: SAGE Publications Ltd, 2011. 75‐76.  

89 Ashman, I, and Diana W. "For or against Corporate Identity? Personification and the Problem of Moral Agency." Journal of Business Ethics 76, no. 1 (Nov 2007n): 83‐95. 

90 Desmidt, S et al. "Looking for the Value of Mission Statements: A Meta‐Analysis of 20 Years of Research." [In English]. Management Decision 49, no. 3 (2011): 468‐83. 

91 Hall, Robert T. "Organizational Ethics in Healthcare." In Encyclopedia of Bioethics, edited by Stephen G. Post, 1940‐44. New York: Macmillan Reference USA, 2004. 

92 Buchholz, RA, and Rosenthal, SB. "Integrating Ethics All the Way Through: The Issue of Moral Agency Reconsidered." Journal of Business Ethics 66, no. 2/3 (2006): 233‐39. 

93 Jurkiewicz, Carole L., and Carolyn R. Thompson. "Conflict of Interest: Organizational Vs. Executive Ethics in Health Care." Journal of Health and Human Services Administration 23, no. 1 (2000): 100‐23. 

94 Ozar, David T. "Profession and Professional Ethics." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2158‐69. New York: Macmillan Reference USA, 2004. 

95 Davis, Michael. Professional Codes. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd.  London: SAGE Publications Ltd., 2011. http://dx.doi.org/10.4135/9781446200971. 

96 Rodwin, Marc A. Conflicts of Interest and the Future of Medicine. Oxford University Press. 2011.  8‐11 97 American Medical Association. "Principles of Medical Ethics." AMA Code of Medical Ethics. June 1, 2001. Accessed May 19, 2015. http://www.ama‐assn.org/ama/pub/physician‐resources/medical‐ethics/code‐medical‐ethics/principles‐medical‐ethics.page. 

98 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 82‐83 99 Purtilo, Ruth B. "Professional–Patient Relationship: Iii. Ethical Issues." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2150‐58. New York: Macmillan Reference USA, 2004. 

100 Post, SG. "Clinical Ethics." Encyclopedia of Bioethics. New York: Macmillan Reference USA, 2004. 101 Eva C. Winkler, Russell L. Gruen. Organizational Ethics. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd.  London: SAGE Publications Ltd. (2011): 73‐74.  

102 Gallagher, Colleen M., and Ryan F. Holmes. "Handling Cases of 'Medical Futility'." HEC Forum 24, no. 2 (Jun 2012): 91‐8. 

103 Lynch, HF. Conflicts of Conscience in Health Care. An Institutional Compromise. MIT Press, 2008. 133‐135 104 McCullough, Laurence B. "Practicing Preventive Ethics‐‐the Keys to Avoiding Ethical Conflicts in Health Care." Physician Executive 31, no. 2 (2005): 18‐21. 

105 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 46‐48 106 Hall, RT. An Introduction to Healthcare Organizational Ethics. Oxford University Press, 2000. 23‐25 107 Gibson, Jennifer L, Douglas K Martin, and Peter A Singer. "Setting Priorities in Health Care Organizations: Criteria, Processes, and Parameters of Success." BMC Health Services Research 4, no. 1, 2004. 4‐25. 

108 Williams Jr, Ralph I  et al. "Reinvigorating the Mission Statement through Top Management Commitment." Management Decision 52, no. 3 (2014): 446. 

109 Forehand, Aimee. "Mission and Organizational Performance in the Healthcare Industry." Journal of Healthcare Management 45, no. 4 (Jul/Aug 2000): 267‐77. 

110 Cady, Steven H., Jane V. Wheeler, Jeff DeWolf, and Michelle Brodke. "Mission, Vision, and Values: What Do They Say?" [In English]. Organization Development Journal 29, no. 1 (Spring 2011): 63‐78. 

111 Goold, Susan Dorr. "Trust and the Ethics of Health Care Institutions." The Hastings Center Report 31, no. 6 (2001): 26‐33. 

Page 155: An Ethical Framework for Organizational Resource

 

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                                                                                                                                                                                                112 Iltis, Ana Smith,. "Values Based Decision Making: Organizational Mission and Integrity." HEC Forum 17, no. 1 (Mar 2005): 6‐17. 

113 Cady, Steven H., Jane V. Wheeler, Jeff DeWolf, and Michelle Brodke. "Mission, Vision, and Values: What Do They Say?" Organization Development Journal 29, no. 1 (Spring 2011): 63‐78. 

114 Graber, David R., and Anne Osborne Kilpatrick. "Establishing Values‐Based Leadership and Value Systems in Healthcare Organizations." Journal of Health and Human Services Administration 31, no. 2 (Fall 2008): 179‐97. 

115 Lynch, HF. Conflicts of Conscience in Health Care. An Institutional Compromise. MIT Press, 2008. 129‐132 116 Weaver, GR. "Virtue in Organizations: Moral Identity as a Foundation for Moral Agency." Organization Studies 27, no. 3 (2006): 341‐68. 

117 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 3‐4 118 US Department of Health and Human Services. Quality Improvement. April 2011. 7‐9 http://www.hrsa.gov/quality/toolbox/508pdfs/qualityimprovement.pdf 

119 Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, CD: National Academy Press, 2001. http://www.nap.edu/html/quality_chasm/reportbrief.pdf 

120 Shore, David A., ed. The Trust Crisis in Healthcare: Causes, Consequences, and Cures. New York: Oxford University Press, 2006. Oxford Scholarship Online, 2009. 49‐55 

121 Pearson, SD et al. No Margin, No Mission. Health Care Organizations and the Quest for Ethical Excellence. Oxford University Press, 2003.1‐3 

122 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 179‐180 123 Shojania KG, Showstack J, Wachter RM. “Assessing Hospital Quality: A Review for Clinicians.” Eff Clin Pract 2001. 4:82‐90. 

124 US Department of Health and Human Services. Quality Improvement. April 2011. 1‐4 http://www.hrsa.gov/quality/toolbox/508pdfs/qualityimprovement.pdf 

125 Naidu, Aditi. "Factors Affecting Patient Satisfaction and Healthcare Quality." International Journal of Health Care Quality Assurance 22, no. 4 (2009): 366‐81. 

126 Agency for Healthcare Research and Quality. “The CAHPS Program.” CAHPS Home. (Retrieved May 19, 2015) https://www.cahps.ahrq.gov/about‐cahps/cahps‐program/index.html 

127 Walley, P., & Gowland, B. "Completing the Circle: From Pd to Pdsa." International Journal of Health Care Quality Assurance 17(6) (2004): 349‐58. 

128 Agency for Healthcare Research and Quality. Improving Healthcare Quality. September 2002. http://archive.ahrq.gov/research/findings/factsheets/errors‐safety/improving‐quality/improving‐health‐care‐quality.pdf 

129 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 184‐185 130 Robert Wachter. Understanding Patient Safety. McGraw HIll, 2007. 3‐12 131 Shore, David A., ed. The Trust Crisis in Healthcare: Causes, Consequences, and Cures. New York: Oxford University Press, 2006. Oxford Scholarship Online, 2009. 59‐64 

132 Shore, David A., ed. The Trust Crisis in Healthcare: Causes, Consequences, and Cures. New York: Oxford University Press, 2006. Oxford Scholarship Online, 2009. 70‐72 

133 Hunt, L. Inventing Human Rights. A History. New York/London: W.W. Norton & Company, 2008. 19‐22 134 Pearson, SD et al. No Margin, No Mission. Health Care Organizations and the Quest for Ethical Excellence. Oxford University Press, 2003. 97‐100 

135 Pearson, SD et al. No Margin, No Mission. Health Care Organizations and the Quest for Ethical Excellence. Oxford University Press, 2003. 113‐115 

136 Jan Helge Solbakk: Vulnerability: A futile or useful principle in Healthcare Ethics? In: Ruth Chadwick, Henk ten Have and Eric M. Meslin (Eds): The SAGE Handbook of Health Care Ethics: Core and Emerging Issues. SAGE Publishers, Los Angeles, 2001, 230‐233 

137 Jan Helge Solbakk: Vulnerability: A futile or useful principle in Healthcare Ethics? In: Ruth Chadwick, Henk ten Have and Eric M. Meslin (Eds): The SAGE Handbook of Health Care Ethics: Core and Emerging Issues. SAGE Publishers, Los Angeles, 2001, p 228‐229 

138 International Bioethics Committee: Report on the Principle of Respect for Human Vulnerability and Human Integrity. United Nations Educational, Scientific and Cultural Organization. France 2013. 1‐3 

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                                                                                                                                                                                                139 International Bioethics Committee: Report on the Principle of Respect for Human Vulnerability and Human Integrity. United Nations Educational, Scientific and Cultural Organization. France 2013.13‐14 

140 Jan Helge Solbakk: Vulnerability: A futile or useful principle in Healthcare Ethics? In: Ruth Chadwick, Henk ten Have and Eric M. Meslin (Eds): The SAGE Handbook of Health Care Ethics: Core and Emerging Issues. SAGE Publishers, Los Angeles, 2001, 234‐236 

141 International Bioethics Committee: Report on the Principle of Respect for Human Vulnerability and Human Integrity. United Nations Educational, Scientific and Cultural Organization. France 2013. 4‐12 

142 McLean 105‐106 143 Martin, Angela K., Nicolas Tavaglione, and Samia Hurst. "Resolving the Conflict: Clarifying 'Vulnerability' in Health Care Ethics." Kennedy Institute of Ethics Journal 24, no. 1 (Mar 2014): 51‐72. 

144 Semplici, Stefano. "The Importance of ‘Social Responsibility’ in the Promotion of Health." Medicine, Health Care and Philosophy 14, no. 4 (2011): 355‐63. 

145 International Bioethics Committee: Report on Social Responsibility and Health. United Nations Educational, Scientific and Cultural Organization. France 2010. 16‐21 

146 International Bioethics Committee: Report on Social Responsibility and Health. United Nations Educational, Scientific and Cultural Organization. France 2010. 26‐33 

147 International Bioethics Committee: Report on Social Responsibility and Health. United Nations Educational, Scientific and Cultural Organization. France 2010. 34‐45 

148 Stone, John R. "Saving and Ignoring Lives: Physicians' Obligations to Address Root Social Influences on Health‐‐Moral Justifications and Educational Implications." Cambridge Quarterly of Healthcare Ethics 19, no. 4 (Oct 2010): 497‐509. 

149 Rothman DJ and Rothman Sheila M. Trust is not enough. Bringing human rights to medicine. New York Review of Books, New York, 2006. 152‐153 

150 Beachamp, L and Childress JF. Principles of Biomedical Ethics, 7th Edition. Oxford University Press, 2013. 249‐251. 

151 Marmot, Michael. "Achieving Health Equity: From Root Causes to Fair Outcomes." [In English]. The Lancet 370, no. 9593 (Sep 2007):1153‐63. 

152 Beachamp, L and Childress JF. Principles of Biomedical Ethics, 7th Edition. Oxford University Press, 2013. 271‐274 

153 Braveman, PA. et al. "Health Disparities and Health Equity: The Issue Is Justice." [In English]. American Journal of Public Health 101, no. S1 (2011): S149‐55. 

154 Wagstaff, Adam. "Poverty and Health Sector Inequalities." World Health Organization. Bulletin of the World Health Organization 80, no. 2 (2002): 97‐105. 

155 Kelleher, J. Paul. "Beneficence, Justice, and Health Care." Kennedy Institute of Ethics Journal 24, no. 1 (Mar 2014 2014‐08‐12 2014): 27‐49. 

156 Farmer, P. Pathologies of Power. Health, Human Rights, and the New War on the Poor. Los Angeles: University of California Press, 2005. 157‐159 

157 Fenton, JD and Fenton, EM. “Bioethics and Human Rights: Access to Health‐Related Goods.” Hastings Center Report, Volume 39, Number 5, September‐October, 2009, 27‐38. 

158 Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000. 5‐7 

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Chapter 4: Social Determinants of Health

4a Social Determinants of Health & Cultural Competency

Social determinants of health – including race, ethnicity, culture, socioeconomic status

and barriers to access – have a serious impact on health outcomes in the United States.

Determining how to address these issues is a challenge exacerbated by the multicultural nature of

the US population. It can be difficult to navigate through the different cultures, beliefs, and

backgrounds that a diverse population offers.

Due to the pluralism created by a multicultural society, bioethicists need to seek a

common ground between methodological differences through moral discourse based on

foundational theories, principles, and casuistry.1 One way to explain this moral discourse is in

terms of religious ethics and secular ethics. Religious medical ethics is based on claims that a

religion has a way of knowing divine truth or divine will and typically presents in two forms –

with truths revealed or naturally knowable by reason.2 Secular ethics, on the other hand, relies on

approaches of reason or approaches of experience or moral sense. 3 Given the diversity of

religious and secular perspectives in a multicultural society (such as the United States), major

challenges are presented by both religious and secular medical ethics foundations. Instead of

choosing an ethical theory that favors a certain group or theory, a normative ethic can be

formulated to address challenges associated with social determinates of health through

foundations and applications of human rights.

Human rights should be the basis of a normative ethical approach to health care ethics in

a multicultural society because it is founded in respect for human vulnerability and justice. This

means that it is an approach that considers the different needs of individuals while uniformly

granting the same rights to all. Human rights can help to address social determinants of health,

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considering the nature of human vulnerability and applying the principle of justice to reduce

health disparities. Through applying human rights principles, organizations can implement

cultural competency programs and policy in order to reduce disparities caused by social

determinants of health and ultimately improve quality of care. In other words, the human rights

principles of respect for human vulnerability and justice can be applied through organizational

policy focused on cultural competency, and ultimately address social determinants of health to

improve quality of care.

4aii Ethical Challenges to Organizational Policy Stemming from Social Determinants of Health

A diverse population with varied races, ethnic backgrounds and belief systems can lead to

major challenges in bioethics and present the need to address ethical pluralism in the context of

diverse philosophical, spiritual, and religious beliefs.4 These challenges are especially pertinent

in relation to social determinants of health. When individuals in a society have varying

backgrounds and belong to diverse social, religious and cultural groups, it can be difficult to

create a health care system that applies to all individuals fairly.

This is further complicated by (real or perceived) weaknesses of traditional bioethics

itself, which often faces criticism that it is based on western principles, methods, and philosophy

and that it is lacking in its attempt to address the role of social and cultural values – specifically

those that define health, illness, pain, and death.5 If those analyzing ethical challenges to health

care hold a specific world view, they may not be able to seriously consider other legitimate

perspectives from other cultural groups. This is one barrier to ethical analysis of multicultural

health promotion, but these barriers include many factors related to: Demographics – such as

age, ethnicity, religion, and education level; Culture – including worldview/perceptions in life,

time orientation, and primary language; and Health care system barriers – including access to

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care, financial resources, and poor doctor-patient communication.6 The various barriers that face

a multicultural society when addressing health disparities related to social determinants of health

must be addressed in order to improve health outcomes based on an ethical foundation of human

rights.

Social determinants of health include key components of race, ethnicity, culture,

socioeconomic status, and access to health care.

Diversity

Race, ethnicity and culture are important factors that have great influence on

socioeconomic status of groups and individuals. These factors can seriously impact the quality

and amount of health care that an individual receives.

Culture, ethnicity and race play important roles in patients’ ability to understand and

interpret health care information and instruction. Culture describes (learned) patterns of social

conduct – including everyday social interaction, local shared local knowledge, language

patterns, family structures, values, symbols, interpretive categories, and ethnic traditions – and

can strongly influence an individual’s understanding of illness, death, dying, decision-making,

truth-telling, decision-making, “reasonableness,” autonomy, meaning symptoms and illness,

understanding of appropriate social roles of family, and attitudes toward advance care planning.7

This patient background has the capacity to influence their ability to make many life-altering

positions and can thereby contribute to health disparities among groups who have a greater

ability to access and apply health care information versus those who do not.

Even when a person understands the health information they are receiving and can access

the health care they need, cultural barriers can persist based on community expectations and also

expectations of oneself. Cultural experiences and religious beliefs can be so intricately tied to a

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person’s personal identity that a person may not feel free to act autonomously when there are

foreseeably adverse consequences of choosing to act any other way than community desires, or

acting in a way that will result in loss or radically altered sense of self. 8 If a person feels that

they will lose their identity by acting against the norms of their culture, they may be unlikely to

act against them. This can be further exacerbated by providers who do not understand the reasons

why a patient acts a certain way because they are unfamiliar with their culture.

Although culture, ethnicity and race should be taken into consideration when making

health decisions, there are some potential pitfalls and weaknesses in focusing on culture and

ethnicity. It can promote cultural stereotypes, “essentialize” values, overlook variations, obscure

importance of other issues such as socioeconomic status, and limit insight into what should be

accommodated or tolerated.9 Health care leaders and providers should be wary of

overgeneralizing based on these factors to avoid discrimination and further exacerbate the health

disparities caused by these factors.

Stereotypes that apply biases or even epidemiological data to the individual without

considering their individual characteristics can be extremely harmful – especially for those in

marginalized groups. Avoiding stereotypes and overgeneralizations based on race, culture and

ethnicity is especially important because of the serious disparities in health care and health

outcomes faced by minorities in the United States. Importantly, there has been an unequivocal

amount of evidence that minority groups often do not get the same level of health care treatment

in the United States. For example, African Americans have been shown to have lower survival

rates for lung cancer than Caucasian Americans, which is largely explained by their lower rate of

surgical treatment – the optimal treatment for early –stage, non-small cell lung cancer.10 In this

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case, the health outcomes of African Americans is directly related to the type and amount of

treatment they tend to be offered.

Other research shows that Asian Americans and Hispanic Americans have been shown to

experience lower patient satisfaction, receive less preventative care services, engage in less

physician counselling, and are less likely to receive care to manage chronic conditions than

African Americans or whites.11 In addition, non-white patients have been shown to be less likely

than white patients to receive adequate pain treatment.12 This shows that different minority

groups have varying experiences with the health care system – making analysis of effect of race,

culture and ethnicity complex, multivariate and multi-layered. Because of the complexity of

analysis, it is also a challenge to determine why these outcomes vary between minority and

majority groups.

The varying health outcomes of different minority groups in the United States could be

attributed to differing views of these groups and their physicians. When the cultural background

of a patient and a physician differs, their opinions on issues such as life-sustaining technology

can differ since they often have faced different life experiences related to ethnicity,

socioeconomic status, gender and access to care.13 When the majority group holds the majority

of health care provider roles, minorities may have fewer opportunities to relate to their caregiver.

There are many ways that health care providers can address these disparities in race,

culture and ethnicity. According to the American College of Physicians, racial and ethnic

disparities can be reduced through changes to the health care system including: providing all

legal residents with health insurance, believing that all patients deserve high quality health care,

acknowledging cultural and linguistic needs of patients, recognizing pre-conceived perceptions,

delivering accessible patient-centered care, promoting a diverse workforce, addressing social

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determinants of health, reducing the effect of environmental stressors, and supporting more

research and data collection related to racial and ethnic disparities.14 These are just some of the

strategies that health care organizational leaders and health care providers can use to reduce or

begin to eliminate the disparities in health based on culture, race and ethnicity.

Culture, race and ethnicity are significant challenges to ethical organizational

policy formation within a multicultural society. These, along with other factors contribute to

disparities in health outcomes. Closely related to culture, race and ethnicity lie health care

disparities created or perpetuated by socioeconomic status.

Socioeconomic status is an important indicator of health status and outcomes. The way

that socioeconomic status affects health can be explained on many levels, and has significant

supporting evidence to support the ways in which its influence functions.

Socioeconomic status influences many health risks that have serious implications for

adverse health outcomes in poor individuals and groups. Low level of wealth or socioeconomic

position moderately contributes to health behavioral risks of obesity, smoking and physical

inactivity for adults 50 and over, meaning that promoting healthier lifestyles among these

populations could help to close the gap in health inequalities.15 This is an important part of the

picture and can be addressed in part by increasing access to health to health care and health

information, and by supporting programs to improve lifestyle influences of poor health

outcomes. This is one part of the picture of health and socioeconomic status, which affects health

on many levels.

Socioeconomic status not only affects physical health, but importantly also has a serious

effect on mental health. Socioeconomic status and demographic variables have been directly and

independently shown impact changes in mental health, which can be attributed (at least partially)

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to increased exposure to stressors experienced by socioeconomically disadvantaged groups.16 A

disadvantaged socioeconomic position has the potential to impose a large amount of undue stress

on an individual and thus impact mental health status. Impaired mental health status then has the

potential to negatively affect socioeconomic status by causing disability, creating a vicious, self-

perpetuating cycle. It is therefore important to address socioeconomic status and its relation to

mental health, with an emphasis on early intervention.

Socioeconomic inequalities can also lead to increased risk of anxiety and depression,

which is a gap that widens over the life course and could be addressed by prevention strategies in

early life.17 An approach to improving mental health for the socioeconomically disadvantaged,

especially at an early age, can improve functional capability and reduce the risk of further

intensifying the negative effects of poverty.

Focusing on groups in low socioeconomic states can shed light on inequalities inherent to

the health care system. For example, socially advantaged better positioned to benefit from

biomedical advances that can lead to social inequalities and it is important to note the health

provider’s influence on decisions, strength and uniformity of recommendations, uniform

protocols, dissemination of health information and design new treatment protocols that prevent

or alleviate health disparities.18 Biomedical science often focuses on social advantaged groups so

redirecting research and health improvement initiatives can begin to address some of the

disparities between availability of interventions to improve health. In addition, conditions and

diseases that particularly affect those in socioeconomically disadvantaged groups can be further

emphasized in research and provision of care to reduce the disparities caused by emphasis on the

wealthiest few.

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The disparities between wealthy and poor patients have many contributing factors.

Physician perception and treatment of socially disadvantaged groups can significantly impact

health outcomes. The way physicians form perceptions about their patients has been shown to

have heavy influence from the patient’s socioeconomic class, with physicians associating

socioeconomic class with perception of a patient’s personality, ability, behavioral tendencies,

and role demands.19 This means that a physician may treat a patient differently based on

perceptions of how they will behave – even if these perceptions are not based in any evidence of

the individual patient’s characteristics. This can affect outcomes for patients who are treated

unfairly based on provider bias.

Absolute socioeconomic position has a great influence on health outcomes, but so does

relative socioeconomic position in terms of income inequality. Income inequality has also been

shown to negatively impact infant mortality, low birthweight, and mortality in people aged 1-14

years, although these outcomes are not universally applicable and are most clearly correlated

within the United States where income inequality is overwhelmingly associated with unequal

distribution of health.20 The correlation between income inequality and negative health outcomes

is another factor related to socioeconomic status that affects outcomes for all individuals – not

just those who are economically disadvantaged. Mortality has been shown to be reduced with

more equal distribution of income, with benefits weighing toward the poor and smaller benefits

shown for the wealthy, which may be explained by the socially corrosive nature of income

inequality.21 Income inequality, in other words, is not good for any member of society – although

the poor are impacted the most severely.

Poor health exacerbates and perpetuates poverty through social marginalization,

disadvantage, vulnerability and discrimination, but can be addressed operationally by

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institutionalizing systematic and routine application of human rights perspectives, strengthening

and extend public health functions, implementing equitable health care financing, ensuring

adequate response to major causes of preventable ill-health among the poor and disadvantaged,

and monitoring implications of development policies.22 Health care organizations, leaders and

providers can foster improved health outcomes by addressing social determinants of health and

improving economic equity for all individuals within the multicultural society.

Further, socioeconomic status is closely related to the ability of an individual to

meaningfully access health care. In addition to race, culture, ethnicity, and socioeconomic status,

barriers to healthcare access are a significant social determinant of health.

Barriers to Access

Access to health care is essential to good health outcomes. Most importantly, health care

access is related to core American values of equality of opportunity, justice, and compassion

which lead to the following ethical obligations: Every member of society must have adequate

health care benefits; The contents and limits of health care benefits must be established through

an ethical process; The health care system must be sustainable; and Stakeholders must be

accountable for clear responsibilities.23 Because health care access is intrinsically tied to core

American beliefs about opportunity, justice and compassion, it should be emphasized when

looking at ways to reduce social disparities of health care.

Health care providers and organizations should work to reduce disparities experienced by

racial and ethnic minorities – such as lower quality and quantity of preventative, diagnostic, and

therapeutic services –by addressing and monitoring the contributing financial and structural

barriers.24 These financial and structural barriers effectively equal barriers to access when they

prevent a patient from obtaining meaningful care. Racial and ethnic minorities disproportionately

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experience inadequate access, which goes against the core American belief of equality of

opportunity. When a person does not have access to care that can help them achieve optimal

level of health, their opportunities to effectively participate in society are significantly

diminished.

Financial barriers are one of the most significant barriers to access faced by those in

disadvantaged groups. Financial barriers can include insurance status or ability to pay for health

care services. This is especially important because the uninsured do significantly worse in both

quality and satisfaction outcomes than the insured.25 When a patient is not able to pay for health

care or health related goods, this means that they do not have access to this care or these goods,

regardless of how geographically easy they would otherwise be to obtain. When patients are not

able to pay for health care, they are prevented from accessing health care services they need,

including preventative and diagnostic services. In addition, they may not be able to receive care

for chronic or disability-causing conditions. This could have serious consequences for long-term

health outcomes.

Barriers to access can be especially stark for minority populations in the United States.

Minorities are less likely to have a regular doctor, to feel like they have a choice in where they

go for care, or to have a regular doctor.26 This can be due to various reasons, but the outcomes

for minorities show that access can be a significant social determinant of health closely related to

race, ethnicity, culture, and socioeconomic status.

Language can also be a significant barrier to access, causing disparities in health

outcomes for minorities. Disparities in access to health care among Hispanic children have been

shown to be largely related to language ability.27 If a person is not able to speak or understand

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the language used by the health care system they have access to, they will not have effective

access to health care.

Effective communication between patient and doctor is critical for good outcomes, yet

many patients who need a language interpreter still go without one.28 Providing patients with

adequate interpretation services and ensuring that they understand key elements of their health,

including their care plan is crucial to reducing health disparities among minority populations.

Some ethnic disparities, especially for Hispanics, have been explained at least in part by

differences in English fluency.29 Understanding language is the first step that a person must take

before they can even begin to understand messages of health care providers and ultimately gain

meaningful access to health care services.

Full access to healthcare includes cultural, linguistic, and financial access.30 This means

that health care should be culturally and linguistically appropriate, as well as affordable for all

groups – including ethnic, racial, and cultural minorities, and those in low socioeconomic

spheres of society. Only when these three conditions are met will all patients be able to

meaningfully access care.

The goal of access to health care is for it to be equitable. Equitable access means equal

access for those in equal need and unequal access for those who have unequal need and are

influenced by factors on the supply side – including geographical availability and proximity,

resource distribution; and the demand side – including individual’s ability to pay for health care,

knowledge, information, cultural beliefs, indirect financial costs, opportunity cost of patient’s

time, and preferences.31 Patients with equal need for certain services should have the same or

similar access to those services, provided that ensuring access is financially and logistically

reasonable.

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This notion can further be explained through human rights principles, which should guide

policy to address the ethical challenges stemming from social determinants of health.

4aii Developing Normative Ethics in a Multicultural Society through Human Rights Principles  

Secular and Religious Bioethics

Secular and religious bioethics are offer competing theories of how to define “right” or

“good” in health care. Many secular philosophers rely on reason – believing that reason can

deem certain behaviors ethical or unethical through thought process or negotiation in social

contracts – or experience and senses – believing that the human body can weight moral benefits

and harms to self and others through sense and perception.32 Religious theories are also common

when approaching ethical theory in health care. Religious theories tend to rely on revealed truth

or natural theology. Revealed religious truth or “faith knowledge” means that members of a

particular religion have knowledge of true morality that has been revealed to them through their

religious doctrine.33 Natural theology is a theory of religious ethics that states that there are

natural ways of knowing moral norms, and that these norms are revealed by reason.34 These

varying and often conflicting theories offer a confusing array of approaches to health care ethics

in multicultural societies.

Human Rights

Choosing one of these normative moral theories – secular or religious – is not possible

because, in a multicultural society, there are conflicting values, backgrounds and cultural beliefs

that keep individuals from agreeing on theories outlining specifics of what is right and what is

wrong. In other words, a multicultural society such as the United States faces moral pluralism, or

morally diverse individuals and groups, which can attempt to engage with each other through

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bridging foundational differences, but should keep in mind that agreement about moral a

philosophy does not necessarily mean that it is justified, i.e. consensus can arise out of pressure

from power structures or mindless conformity rather than true moral justification.35 Using

methodologies of bridging theories and justifying actions can be helpful when navigating

through differing moral beliefs within a multicultural society, however there are foundational

principles that should be started with and used as a foundation for these justifications. These

foundational principles are under the umbrella of human rights.

Human rights principles are principles that apply to everyone simply for the reason that

they are part of humankind. Human rights can and should be applied to health care ethics

because of its universal application and ability to create a guideline or framework for ethical

decision-making.

The United Nations’ Universal Declaration on Human Rights provides common

standards for fundamental human rights to be universally protected, and includes articles

outlining these established rights.36 Especially important for the right to health care are the

human rights principles outlined in the declaration of respect for human vulnerability and justice.

To be vulnerable has been defined as “… a means to face a significant probability of

incurring an identifiable harm while substantially lacking ability and/or means to protect

oneself.”37 All humans are – or are at risk for – being vulnerable at some point in their lifetime,

although some individuals facet a greater risk for vulnerability than others. In health care, and

often in terms of medical research, some patients are considered to be more vulnerable than

others. The International Ethical Guidelines for Biomedical Research Involving Human Subjects,

prepared by the Council for International Organizations of Medical Sciences (CIOMS) in

collaboration with the World Health Organization (WHO), defines vulnerability as “a substantial

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incapacity to protect one’s own interests owing to such impediments as lack of capability to give

informed consent, lack of alternative means of obtaining medical care or other expensive

necessities, or being a junior or subordinate member of a hierarchical group.”38 A person is

vulnerable when they are not able to protect themselves and are at a higher risk for harm.

All humans face vulnerability making it a shared trait of humankind and one in which

incurs social and moral obligation. Societies have an obligation to protect their most vulnerable,

and those within a society can feel comfortable that if they ever develop vulnerability, they too

will be cared for.

Human vulnerability is closely related to social determinants of health, including race,

ethnicity, culture, socioeconomic status and health care access. Vulnerable populations face

critical barriers to care associated with multifactorial risk, including minority race, low

socioeconomic status and lack of health care access, which predispose and enable poor access to

care, and result in unmet healthcare needs associated with cost.39 Certain groups are more

vulnerable than others and therefore need more social protections than others. These social

protections extend to the protection of health for vulnerable populations. An ethical framework

for addressing ethical issues in a multicultural society begins with the acknowledgement of

human vulnerability and effort to address and protect vulnerable individuals and groups. Those

that are socially disadvantaged deserve special protection, consideration and prioritization based

on their vulnerable status.

Health care is often touted as being unbiased, as shown in the emphasis on evidence-

based medicine; however, evidence-based medicine often inherently excludes benefits to

vulnerable populations. Evidence-based medicine’s implicit promise is a commitment to

objectivity and fair distribution, but vulnerable groups are often excluded from these benefits and

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inequalities are often actually increased due to low socioeconomic status, ethnicity, age, gender,

and mental ill health.40 If the focus on medical research that forms the foundation for evidence-

based medicine is based on wealthy and advantaged populations only, these evidence-based

interventions will be inherently designed to serve advantaged populations and may ignore the

needs of vulnerable populations altogether.

In consideration of the nature of human vulnerability, the principle of justice should be

applied to ensure that health care is fairly provided to those who are disadvantaged, with health

care resources prioritizing those who need them the most.

Justice is important in health care especially because of the implications that injustices

could incur on society as a whole. Health care deserves special protection because of its special

moral importance founded in social obligation to protect of opportunity, meaning that health care

helps to protect normal functioning of individuals and thus protects their ability to participate in

political, social, economic life of society.41 Health is necessary for people to reach their basic

functional capacity and most importantly to realize opportunity to meaningfully participate in

society.

In a multicultural society, justice must be approached from a human rights perspective.

Moral norms differ culture to culture which sometimes leads to a gap between is/ought, meaning

that a society’s moral norms can explain why a norm is present yet these norms may still not be

morally justified.42 Human vulnerability combined with justice shows that those who are most

vulnerable should be protected and resources provided should coincide with need. In this model,

one group will not necessarily be prioritized over another because once a persons’ need is gone,

they will enter back into the group receiving the fewer resources. One group or type of individual

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will not always get more resources unless they always need more resources, which would be

unlikely or very rare.

Among many approaches, ethical decision-making can be based on utility (the

greatest good for the greatest number,) deontology (nature of duty,) or consequentialism

(decisions based on their consequences,) but a just outcome balances these approaches, as well as

accountability and learning.43 Most importantly, these approaches should be founded in respect

for human vulnerability, with the specifics of decisions made based on applicable theories. The

basis for which goods and services should be prioritized should be based on human rights.

Justice involves priority setting – including how to use resources, which outcomes should

be emphasized, to what degree to give priority to those who are worse off – which can be

achieved through a model with four conditions: a publicity condition, a relevance condition

(reasonable explanation of priorities), a revision and appeals condition, and a regulative

condition.44 In health care, this priority setting is and should be very closely related to human

rights, specifically respect for human vulnerability.

This definition of justice couched in respect for human vulnerability is necessary

in order to respect the multicultural layers of society and needs of specific groups within a

multicultural society. There is cross-cultural variation in understanding of morality including

what is “reasonable” and “normal,” attitudes toward health and healing, beliefs about illness and

suffering, beliefs about death, family obligations and what constitutes norms, leading to and

contextualized patterns of social life accounts of moral reasoning.45 These variations in specifics

about what is reasonable and what needs to be done can still be respected within the confines of

respect for human vulnerability and justice.

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Human vulnerability and justice will determine when there is need for intervention and

the amount of resources society is willing to contribute to that intervention. Once this has been

decided, strategies of cultural competency can and should be used to determine details and

nuances of providing those resources. Organizational policy focused on cultural competency and

based on human rights principles of respect for human vulnerability and justice can therefore

alleviate effects of social determinants of health and ultimately improve health care quality.

4aiii Organizational Policy focused on Cultural Competency to address Social Determinants of Health & Improve Quality

Human rights serve as a foundation for ethical policy within health care organizations. In

order to begin addressing the ethical challenges presented by a multicultural society – including

race, ethnicity, culture, socioeconomic status, and barriers to access – health care organizations

should develop a policy of cultural competency. When founded in human rights, this

organizational policy can impact social determinants of health and ultimately improve quality of

care.

Organizational Policy Focused on Cultural Competency

Cultural competency is the tool structured by organizational policy that can begin to

address the ethical challenges facing multicultural societies. It can help to address the social

determinants of health including race, ethnicity, culture, socioeconomic status, and access. It is

well-founded in the human rights principles of respect for human vulnerability and justice, and

can help organizations achieve their goals of improved quality of care.

Cultural competence falls into three buckets – organizational cultural competence,

systematic cultural competence, and clinical cultural competence, each with their own unique

challenges such as problems with lack of diversity in health care leadership and workforce,

poorly designed systems for diverse patient populations, and poor cross-cultural communication

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between providers and patients.46 Organizational policy can address all of these buckets.

Organizational cultural competence involves the health care organization having structures in

place for a culturally competent environment for employees and patients. Systematic cultural

competence means culturally competent systems within the organization that facilitate culturally

competent care. Clinical cultural competence is at the provider and staff level for providing

culturally competent clinical care for patients.

Health care organizations can approach cultural competence using many strategies.

Health care organization interventions can include evidence-based cost control, improving

financial incentive structure, providing meaningful interpretation services, using community

health workers, incorporating multi-disciplinary teams, and improving patient education and

patient empowerment.47 The organization can use evidence-based cost control as a justification

for enhancing cultural competence policy and training within its organization. The health care

organization can improve the financial incentive structure for providing culturally competent

care. It can provide interpretation services for all patients who need them. It can incorporate

community health workers who understand the cultural nuances and language of the patients

who live within the same community. The organization can also incorporate multidisciplinary

teams to emphasize the importance of cultural competency. In addition, organizations can

improve patient education by including elements of cultural competence, thereby empowering

the patient to participate in their health-care decision-making with cultural sensitivity.

Organizations face many challenges when creating policy based on human rights and

cultural competency. Legal, regulatory and policy interventions can create systematic challenges

to a multicultural society – creating defragmentation of healthcare financing and delivery and

policies to that affect doctor-patient relationships.48 Organizations must work within the confines

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of the legal, regulatory and policy environment in which it is entrenched and create

complementary organizational policies to improve cultural competency. This is not to say that

organizations should be the only level concerned about cultural competency.

All levels of the health care system, including payers and regulatory bodies, should

emphasize cultural competence at a system level, striving to provide culturally and linguistically

appropriate health care services, which will ultimately impact access, utilization, and health

status of minorities.49 Health care organizations such as hospitals and health care systems should

work together with payers and regulatory bodies to create policy that provides the most benefit

for the patient population.

One way to structure this can be implemented is through continuing medical education

(CME,) which can provide cultural competence training, guide providers to develop skills for

culturally and linguistically competent health care, and foster self-reflection, critical thinking,

and cultural humility.50 Continuing medical education is an excellent avenue for training staff

and providers on cultural competence. Since there is expectation for ongoing training and

learning, cultural competence education can be a consistent part of continuous learning.

Residency training is another important avenue for improving cultural competence in

health care. Pediatric residents who have experience in cross-cultural care have felt more

prepared to care for the diverse needs of children in the US – although more attention is needed

to address patients who have limited English proficiency, are new immigrants, or have differing

religious affiliations than their provider.51 Academic health care organizations can provide and

encourage residents to participate in training related to cultural competence. This is important

because resident physicians have self-reported that their preparedness for cultural competency

lags behind their technical and clinical skills.52 In order for residents to be able to fully realize

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their abilities to care for patients, they will need to know how to provide culturally competent

care. Since this training is often not adequately provided in medical school, resident training

programs should provide aspects of cultural competence education. Including cultural

competence in resident training programs early on could have long-term effects of culturally

competent care throughout the rest of a resident’s career.

When providing cross-cultural training, whether it be for residents, clinical faculty or

staff, cross-cultural education can use interactive, experiential, practical, case-based approaches

to teach these attitudes, knowledge and skills.53 These techniques will help cross-cultural training

have a high level of impact as intended by the organization.

Cultural competence training should be multidimensional, addressing all of the aspects

that may affect a patient’s ability to access culturally competent care. Organizational,

professional, and individual levels of cultural competence can be conceptualized through a three-

dimensional model including race and culture-specific attributes of competence, awareness of

personal beliefs, and skills.54 Employees of an organization – including administrators,

physicians and staff can follow this model to improve cultural competency in their area. This can

and should begin with an understanding of race and culture-specific issues facing employees and

patients.

The cultural competency training can then migrate to an analysis of one’s own personal

beliefs about culture. Last, employees and providers should develop skills for addressing cultural

issues within the health care setting. These three levels of cultural competence will build on one

another and should all be included in a cultural competency training policy.

A system of cultural competency should provide a structure that facilitates organizations

and providers in their development of cultural awareness, cultural knowledge, interpersonal

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communication skills, cultural collaboration, avoidance of stereotyping, cultural experience, and

conviction.55 The awareness and knowledge of cultures will help the provider or staff member

understand the issues, and then use interpersonal communication skills and cultural collaboration

to share in decision-making with culturally diverse patients. Cultural competence programs

should also emphasize avoiding stereotypes and having cultural experiences. This will lead to

conviction about cultural understanding and acceptance, which will be the ultimate goal of

cultural competence training.

Cultural competency training is only one part of organizational policy focused on cultural

competency. Culturally competent health care organizations provide culturally and linguistically

appropriate services, recruit and retain staff who reflect cultural diversity, provide interpreter

services or bilingual providers, facilitate cultural competency training, and offer linguistically

and culturally appropriate health education materials.56 The organization must take steps in

addition to cultural competency training to ensure a culturally competent organization.

The organization should provide services appropriate to its population and also ensure

that their staff and providers reflect the cultural diversity of the population they serve. In

addition, patient education materials developed and available to patients should be culturally and

linguistically appropriate for the patient population/s served.

Organizational policy to cultivate cultural competency should not stop at understanding

diverse cultures. Cultural competency, including linguistic competency, goes beyond cultural

awareness or sensitivity though and requires the cultivation of cultural knowledge, development

of skills to apply cultural knowledge, and policies that provide a structure for providers to deliver

culturally competent care.57 Employees of a health care organization should not only understand

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what cultural competency is, they should continue to cultivate knowledge and develop skills to

apply their training in the clinical setting.

In addition, organizations can use various techniques to address cultural competence

include interpreter services, recruitment and retention of minority staff, training, coordinating

with traditional healers, use of community health workers, culturally competent health

promotion, including family and/or community members, immersion into another culture, and/or

administrative and organizational accommodation.58

When an individual staff member or employee approaches a culturally diverse

population, they should take steps to ensure that they are facilitating cultural competence with all

patients. Steps toward cultural competence should include cultivating attitudes, developing

awareness of impact culture has social values and health beliefs, obtaining background

information about patient’s cultures, performing a cultural assessment, planning culturally

sensitive care, and avoiding defensiveness.59 The provider or staff member should understand

that each patient may come from a culturally different perspective than their own and not assume

that they know about the patient’s cultural background and preferences.

Getting background about the patient and performing a cultural assessment will help the

provider to avoid harmful stereotyping and ultimately provide culturally appropriate care. The

provider should avoid begin defensive during this process and learn from their experiences and

mistakes. Providers and staff should identify cultural patterns, develop individualized care plans,

and engage in cross-cultural communication (considering all types of communication including

meanings associated with eye contact, touch, silence, space and distance) by adopting attitudes,

developing awareness, and performing cultural assessment.60 In addition, guidelines for

approaching cultural competency can include listening with sympathy and understanding,

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explaining perceptions of the problem, acknowledging and discuss difference and similarities,

recommending treatment, and then negotiating treatment.61

Understanding one’s own cultural perspective is an important part of cultural competency

training. Physicians and health care staff must acknowledge their own potential biases when

approaching a culturally diverse population. If a provider is unable to introspectively look to see

how their biases may affect their care for a patient, they may inadvertently favor patients who are

most culturally, ethnically, racially, or theologically like themselves.

A cultural competency curriculum should focus on examining and understanding

attitudes, gaining knowledge of existing disparities, acquiring communication skills,

understanding one’s own racial and cultural background, understanding the concept of cultural

diversity, identifying types and cause of disparities, familiarity the community where practice is,

ability to conduct cross-cultural and cross-language clinical encounters, and use of patient

centered approach.62 These techniques and approaches will help the provider to navigate through

a culturally competent episode of care and should be an emphasis for cultural competency

training.

Health care organizations can look to the National Standards for Culturally and

Linguistically Appropriate Services in Health and Health Care (National CLAS Standards) for

guidance on developing cultural competency policies. The CLAS standards include provisions

for governance, leadership, workforce, communication and language assistance, engagement,

continuous improvement and accountability – with the goals of decreasing health disparities,

enhancing health equity, and improving quality.63 These can be used as a foundation for policy

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development and implementation within health care organizations to foster culturally competent

care.

Justification for organizational policy focused on cultural competency is based on human

rights – specifically justice for patients and respect for their vulnerability. Patients facing

disparities related to social determinants of health – race, ethnicity, culture, socioeconomic

status, and access – are in particular need of culturally competent care as vulnerable populations.

Social Determinants of Health & Quality of Care

Social determinants of health can and should be addressed through cultural competency

programs within health care organizations. Factors that affect social determinants of health such

as culture, ethnicity, and race will be more adequately addressed when an organization has an

effective cultural competency program.

Cultural competency begin with a cultural assessment. Cultural assessment should

include demographic characteristics such as age, education, occupation and income, culture-

specific epidemiological and environmental influences, and general and specific cultural

characteristics – such as cosmology, time orientation, perceptions of self, and norms, values,

customs, and general and specific health beliefs and practices such as explanatory models,

response to illness, and health behavior practices, and western health care organization and

assessment – such as examining one’s own cultural competence and sensitivity, organizational

policy and mission, and facilities and program preparation.64 This cultural assessment will help

the health care provider determine potential social factors that may affect their patient’s health. It

will also help to keep the provider from making overgeneralizations or having prejudices based

on patient’s demographic characteristics by learning about the patient’s unique background and

risk factors. Cultural assessment will also help the provider learn specifics about the patient’s

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culture that they may not have been aware of but could affect the care the patient receives. With

an effective cultural assessment, the provider can tailor the patient’s assessment and course of

treatment to their individual needs, considering their background, values and beliefs.

Patient-centeredness, or focus on the patient’s specific needs and goals is another tool

that providers can use, although a patient-centered approach is not an adequate replacement for

cultural competence. Cultural competence focuses on the needs of minority and disadvantaged

groups while patient centeredness does not inherently address these issues –

although these two concepts should work together jointly to deliver high-quality care and

addresses issues of quality, equity, health disparities, and care for disadvantaged populations.65

Cultural competence is needed specifically to address social determinants of health that may give

certain groups or individuals a disadvantages in achieving optimal health or accessing health

care.

When a provider is working through cultural differences with a patient, they can use

justification to determine the best course of action. Justification can include aspects of time,

place, and culture, with a claim justified without necessarily admitting its moral truth and carried

out using “bridge concepts,” inter-comparative dialogue, ongoing consensus, and maximizing

respect for diversity and pluralism.66 This does not mean that the provider needs to agree with

the patient’s point of view, but if the two parties can understand each other’s’ justification for

certain decisions, it can help to come to a decision that both can accept.

Providers can also use techniques of cross-cultural communication to address disparities

caused by social determinants of health. Cross-cultural communication can be improved by

addressing health literacy, focusing on messages, becoming bilingual, understanding language

nuances, understanding of nonverbal interpretations, and using interpreters.67 These techniques

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can help patients who are in disadvantaged social, ethnic, or cultural groups to understand their

care and how to navigate the health care system. Cross-cultural communication skills are

important for understanding between providers and patients who may have very different

backgrounds, beliefs and education. They can help to give providers a foundation for addressing

issues with their patients that they may not otherwise understand without careful consideration.

It is also important that organizational policy and employees within an organization

understand patient literacy and, more specific, health literacy of patients. Health literacy

indicates the degree that an individual is capable of obtaining, processing and understanding

basic health information, and directly influences their capacity to make good healthcare

decisions, and to communicate about their health.68 Even if a patient can read, they may not be

able to read and understand critical health care information. Making sure that verbal and written

communication tools are in a level of health care literacy that patients can understand is a crucial

step for providing adequate, appropriate, culturally competent care to patients and ultimately

addressing the health disparities caused by social determinates of health related to these factors.

Similar to cultural competence, cultural humility is a commitment to self-evaluation and

self-critique, addressing power imbalance between patient/physician, mutually beneficial

advocacy partnerships, and patient-focused interviewing and care as a lifelong commitment.69

Providers can use cultural humility on an ongoing basis to improve their communication with

culturally diverse patient populations. This technique provides an opportunity for continuous

improvement and self-reflection for health care providers and has the potential to enrich the

provider-patient relationship.

Based on the effect of sociocultural background on beliefs and behaviors, residents and

medical students should be especially participate in cultural competence programs, including

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analysis of individual patient social context and belief system, avoidance of generalizations,

improvement in ability to understand, improvement in communication, and exploration of

meaning of illness within the patient’s social context.70 Residents and medical students are

learning the skills that they will take with them throughout their career, so emphasizing cultural

competency and giving future and young physicians the tools to provide culturally competent

care will have long-term positive effects.

Cultural competence is critical for addressing social determinants of health. Providing

culturally and linguistically appropriate services in healthcare can help to respond to

demographic changes, eliminate health disparities, improve quality, meet regulatory mandates,

give a competitive edge in the market place, and decrease risk of liability for health care

systems.71 Through cultural competence, social determinants of health can be addressed and

health care quality will improve.

Culture, environment, socioeconomic status and healthcare access contribute to

disproportionate adverse health outcomes experienced by minorities in the United States, and are

strongly related to the physician-patient trust relationship, workforce opportunities, public health,

costs to the economy, and overall quality.72 These key social determinants of health are closely

related to health care quality outcomes, and can be improved by interventions included in

cultural competency training.

Cultural competency is crucial for addressing social determinants of health to improve

quality. It is justified based on human rights principles, especially the respect for human

vulnerability and justice. Respecting certain aspects of a person’s culture, race, ethnicity, or

background that may cause them to be vulnerable is a key tenet of cultural competency. Using

cultural competency to improve quality is founded in justice because it is creating a fairer

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environment of opportunities and social involvement which people can only achieve if they have

a baseline level of health. Factors that are out of a patient’s control like their culture and ethnicity

should not be a penalty for a patient to receive top quality care.

Health care outcomes can be improved for providers and organizations that emphasize

social determinants of health, implementing cultural competency programs to address disparities

they cause. For example, pain management could be improved through better communication

because racial and ethnic disparities in pain perception, assessment and treatment call for

education and treatment approaches that are more targeted to individual patient needs.73

Approaches to creating better understanding between provider and patient will help to facilitate

these improvements.

Disparities in health care quality can be addressed by recognizing them as a significant

quality problem, improving collection of relevant and reliable data, defining performance

measures stratified by socioeconomic position and race/ethnicity, examining population-wide

performance measures that are adjusted for socioeconomic position and race/ethnicity, and

approaching relationships between socioeconomic position and race/ethnicity in relation to

morbidity.74 The disparities caused by social determinants of health must first be recognized

before they can be addressed. Next, data to monitor these disparities and show specific areas of

improvement can help to focus goals of quality improvement through cultural competency.

These goals can be interpreted through definition of performance measures that are

stratified by key socioeconomic factors. Socioeconomic group-specific data can then be

compared against overall outcomes to see where there are disparities and which groups have the

biggest gaps in outcomes. Importantly, an analysis should also be completed on the intersection

of socioeconomic status and race/ethnicity disparities since these factors are intertwined and

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analyzing their relationship may provide key insights on how to address them to improve quality.

Cultural competency techniques can then be used to address any issues found between different

ethnic, racial, cultural, and socioeconomic groups.

Cultural competency to improve health disparities is increasingly important as these

disparities become more acute and more prevalent. More than 30% of medical expenses can be

attributed to disparities in health experienced by minorities, which means that eliminating

disparities could reduce costs to the US health care system through the reduction of direct

expenses associated to providing care to sick and disadvantaged population as well as indirect

costs including lost productivity, absenteeism, lost wages, family leave, and quality of life.75

With limited health care resources, resource allocation and cost is an increasingly important

aspect of health care quality. Eliminating or reducing the disparities in health experienced by

minorities could have a huge impact on not just the quality of life, but also the costs to the

healthcare system, which has a limited amount of resources.

Additionally, increasing recognition of cultural influences can improve quality in

healthcare and also improve a health care organization’s bottom line by appealing to minority

customers, competing for private purchaser business, responding to public purchaser demands

and improving cost-effectiveness.76 This means that implementing cultural competency programs

can not only reduce costs for hospitals and health care systems, but could also help to bring in

more revenue. Minority populations are growing in the US, and health care organizations should

recognize their importance in growing market share for their organization. Appealing to minority

populations is then not only the right thing to do, but also the approach that makes the most sense

from a financial perspective.

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Cultural competency is important because it can cultivate an understanding between

providers and patients and help them to understand and participate in their own health care.

Cultural competency is a crucial tool that allows providers and patients to cultivate knowledge,

awareness and respect, thus leading to a satisfactory understanding between provider and patient,

maximum patient compliance, and good outcomes.77 Patients who understand their providers

would be more equipped to follow instructions than those who are facing miscommunication

with their provider based on language or cultural barriers to communication.

Cultural competency and quality health system level factors, such as access to care,

should address key determinants of health that contribute to disparities and even though evidence

base has not been fully developed, expert opinion has indicated that cultural competency is

imperative to improving quality and eliminating health disparities.78 More research is needed on

the true effect of cultural competency on health outcomes, but it is shown as a promising, easy

and cost-effective way to address disparities in health care that reduce quality outcomes. Cultural

competency can improve these outcomes by improving a patient’s effective access to health care

and facilitate compliance and satisfaction through mutual understanding.

Evidence to support cultural and linguistic competence programs are in early the early

development phase, although the literature provides examples of benefits in terms of quality and

effectiveness of care, health outcomes and well-being with early promising but not conclusive

early results.79 Research supporting a relationship between cultural competency and patient

outcomes has been limited in depth and scope, so there is a need to increase resources to look at

cultural competency education to improve health outcomes.80 Future areas for research include

mechanisms for how cultural competency improves quality, which aspects of quality are most

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affected by cultural competency and to what degree does cultural competency improve quality

outcomes.

Cultural competency is an important part of hospital policy to improve quality outcomes.

It can help to alleviate disparities caused by social determinants of health. It is based on a sound

ethical foundation of human rights – specifically respect for human vulnerability and justice.

Although cultural competency is extremely important, it still cannot work on its own in a

silo. In order for cultural competency to fulfil its full potential, it must be include a multi-faceted

approach. It must be a multi-level, coordinated effort with the role of patient, provider, and

context and as equally important in achieving the goals of eliminating racial and ethnic

disparities in health, improving health care quality, and achieving financial imperatives.81 With

this type of approach, cultural competency as part of an overarching organizational policy to

reduce health disparities will effectively impact quality outcomes in health care.

Determining how to approach ethical issues and justifying decisions within a

multicultural society is challenging. Justification is relative to time, place and culture, and

necessitates inter-comparative dialogue, ongoing consensus and idea of bridge concepts to

maximize respect for diversity and pluralism.82 Justification for health care decisions should be

based on human rights in order to decrease health disparities that result in negative outcomes

caused by social determinants of health. Cultural competency can help providers and patients

arrive at a mutually-agreed upon decision through these approaches. This mutual decision-

making can help to improve quality by increasing the patient’s understanding, compliance and

satisfaction. It can also help patients to make decisions based on their specific health goals and

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goals of care. Cultural competency is a tool to navigate decision-making in a multicultural

environment.

Health care leaders can begin to address some of the challenges arising from health care

disparities by increasing interdisciplinary involvement, balancing universalism and particularism,

improving education and training of bioethicists to analyze these issues more deeply, and

creating distance from the divisive ideological politics.83 In a multicultural, pluralistic society

different perspectives on ethical decision-making should be considered, but human rights should

be considered the most basic foundation for this decision-making, specifically the human rights

principles of respect for vulnerability and justice. These human rights principles are key to

addressing the social determinants of health that lead to poor health care outcomes – including

race, ethnicity, culture, socioeconomic status and healthcare access. When addressing issues

within a multicultural society specifically, cultural competency can be used as a tool to decrease

health disparities caused by social determinates of health and therefore protect human rights.

This approach will ultimately improve quality outcomes.

4b Social Determinants and Shared Decision-Making 4bi Applying Clinical Ethics within Health Care Organizations through Shared Decision-Making

Shared decision-making describes a process where physicians and patients can

collaborate to determine a course of action that is founded in the patient’s values and goals. It

should be carried out through organizational policy related to informed consent and ethics

consultation. The roles of the organization, the physician, the patient, surrogates when necessary,

and ethics committees are integral components of the shared decision-making process.

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What is Shared Decision-Making?

Shared decision-making can be used by health care providers and patients to determine

the best treatment option based on the patient’s values, beliefs and goals. The essential elements

of this process are: recognizing that decision needs to be made, understanding the evidence, and

incorporating patient values.84 First, the patient and physician must discuss the decision that they

are facing and determine the options available. Second, evidence related to the risks and benefits

of each option must be reviewed, including the likelihood and severity of each risk and benefit.

Third, the patient and physician should discuss the options, along with their evidence-based risks

and benefits in terms of the patient’s values and goals. This process can facilitate significant

positive outcomes for the patients.

Shared decision-making can improve care quality, improve patient experience, and

reduce costs – including the cost of surgeries and hospital admissions – through low-cost

interventions such as telephone health coaching.85 When patients have a chance to consider the

options along with their risks and benefits as they relate to their personal values, beliefs and

goals, they have the information that they need to make a truly informed decision.

Some patients and physicians face barriers to shared decision-making which should be

addressed. Issues that can cause patient reluctance to engaging in shared decision-making, such

as perceived vulnerability to physician’s good will and authority, time pressures, and fear of

being categorized as difficult, can be addressed through multifaceted structural approach

including provision of adequate reimbursement, implementation of decision-support tools,

reorganization of care, addressing differences in perspectives, and working at the organizational

level to facilitate a supportive culture and policy.86 Organizations can institute polices based on

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this structural approach to facilitate shared decision-making between the physicians and patients

who interact within their system.

In addition, organizations can provide physicians with the education and tools to help

patients participate in shared decision-making. Barriers to shared decision-making can be

addressed at the physician level by making patients feel supported, empowered, and emotionally

safe, by using verbal and non-verbal cues of respect, addressing health literacy barriers, engaging

family members, and asking patients about fears, and sending affirming messages.87 Physicians

should be aware of the barriers that patients may be facing and proactively address these

potential barriers. At the same time, the organization should work to create a system and

structure that supports the shared decision-making process for both physicians and patients. In

other words, the systematic barriers to shared decision-making should be addressed through a

participatory, collaborative approach at the organizational, practice and physician level.88

Specifically, the organization should focus on policy related to informed consent and ethics

consultation to support shared decision-making and reduce barriers that physicians and patients

face when making decisions.

Informed Consent: The Roles of the Health Care Organization, the Physician, the Patient and the Surrogate

Informed consent is a crucial component of shared decision-making. Informed consent

encompasses legal rules, ethical doctrine, and an interpersonal processes based upon rights and

duties, as well as consequences of actions, and is intended to protect bodily integrity and

autonomy.89 It is the mechanism in which patient autonomy and right to make decisions about

one’s own body and health are fulfilled. Legal or institutionally effective rules and requirements

of informed consent are intended to create conditions that enable autonomous authorization and

promote shared decision-making.90 The health care organization, the physician, the patient have

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important roles in this process. When the patient is incapacitated, the surrogate has an important

role as well.

Informed consent is the practical application of autonomy in the health care setting and is

carried out when the patient is informed of benefits and risks, understands the relevant

information, can comprehend the information given to them, and gives documented consent.91 It

is crucial for shared decision-making since it supports and protects the patient’s right to make

decisions about their health care. The organization’s role in this process is to create policy that

supports a robust informed consent policy that supports an ongoing process of physician-patient

collaboration.

Policies that support his process should promote shared decision-making, protect a

patient’s right to self-determination, promote well-being through discussion of pertinent

information and facilitate the patient’s voluntary agreement with their treatment plan.92 The

organization creates the policy and culture which facilitates this process. Importantly, informed

consent should be a process rather than an event, with medical decision-making as continuous

process throughout course of physician-patient relationship, where information is disclosed as it

becomes available, and receive information over time.93 The organization will create the

environment in which this process is possible, impossible, encouraged or discouraged. This

environment includes support for physicians to spend time with the patient throughout this

process.

The organization’s role is important in facilitating the physician-patient relationship,

and also when a patient is incapable of making their own decisions. A healthcare institution can

have a formal procedure to govern the process of choosing a surrogate, especially for cases when

patient does not have an advance directive or has not expressed their wishes related to a

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surrogate decision-maker.94 The health care organization should have a structure and policy in

place for when these difficult questions arise. The organization’s policy should therefore

consider the role of the physician, the patient and the surrogate related to informed consent.

The physician’s role within the context of shared decision-making is to partner with the

patient, providing the patient with all relevant and necessary information needed to make an

informed decision. An essential element of informed consent is the disclosure performed by the

physician. Disclosure should include information about nature and purpose of proposed

treatment, risks, benefits, and available alternatives.95 The physician should provide all pertinent

information and make sure that the patient both understands and voluntarily consents to the

proposed course of treatment. Importantly, legally valid consent must include understanding and

voluntariness.96 Truth-telling is also an important part of this process.

Arguments for truth-telling include respect for others, respecting right to self-

determination, promoting fidelity and promise keeping, building trust-based relationships,

allowing a patient to make choices consistent with goals and values, promoting feelings of self-

control, and preparing for the future; while arguments against disclosure can include culture-

based comfort with disclosing medical information and acknowledging the importance of hope.97

The physician should weigh these considerations, but always prioritize the patient’s right to have

all relevant information and make autonomous decisions. With informed consent as a process

rather than a discrete event, the physician can share the information as it becomes relevant to

prevent a burdensome, overwhelming flood of information to the patient. In the shared decision-

making process, the physician can provide information to the patient as it becomes important.

This process of consent in the clinical setting should be carried out by establishing the

relationship, defining the problem, ascertaining goals of treatment, selecting an approach to

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treatment, and follow-up.98 As a patient’s condition or context changes, their informed consent

for specific treatment options may change as well, so informed consent should not occur as a

discrete point in time, but continuously over the course of the physician-patient relationship.

The physician’s role is to provide the relevant information and to partner with the patient

to determine the best course of treatment. A patient does not have the right to receive any

treatment they demand, but they do have the right to reject a physician’s recommendation, even

if the physician considers their recommendation to be in the patient’s best interest, especially

because the patient is ultimately the person who can make a final judgment on quality of life

goals.99 The partnership created through shared decision-making mediates differing opinions that

may occur between the physician and patient. The physician ultimately is providing the

information and options, but the patient ultimately makes a decision on whether they want the

offered treatment or not.

One of the physician’s primary roles is to disclose information. Although there are

arguments for nondisclosure – such as when it is employed to avoid serious harm, perform

culturally appropriate care, or if it is in response to a patient request – disclosure generally can do

more benefit than harm because it allows patients to make informed decisions.100 Only when the

patient has all of the relevant information can he or she make an informed decision about health

care.

The patient’s role in informed consent is to provide values and goals for decision-making.

The major goals of informed consent include protection of the patient’s well-being and

promotion of autonomy.101 The patient is the central piece to informed consent since only he or

she can define what well-being means to them. The patient’s autonomy, based on their values

and goals, is central to the informed consent process.

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Respecting a patient’s autonomy requires that patient preferences - based on patient’s

own experience, beliefs, and values – be respected, acknowledging the patient’s right to self-

determination, including the right to accept or reject recommendations of physician.102 The

patient’s role is to weigh the information and options against their own values and decide a

course of action.

A patient’s right to refusal is fundamental to concept of informed consent and patients

should be permitted to refuse treatments even if the treatment is high benefit and low risk.103 The

patient can refuse based on their own personal values and goals of treatment. The health care

organization, physician, nor any other member of the patient’s care team can make the decision

for the patient since the patient is the expert on their desired outcome – even if their desired

outcome is not what someone else would want. As long as the patient’s decisions are based on

clearly articulated values and beliefs founded in logical reasoning, the patient’s wishes must be

respected.

The patient’s autonomous choice should be protected to the extent that is possible. That

being said, complete autonomy can be difficult to achieve in a practical setting. This is because

all actions have some degree of both internal and external influences, including pressure,

possible fear of retribution, and emotional or mental weakness – although these influences

should be avoided as much as possible on the grounds of avoiding fraud and duress, promoting

of rational decisions, preventing abuse, promoting health benefits, improving doctor-patient

relationships, demystifying medicine for patients, and reducing miscommunication.104 External

influences to the patient’s decision-making process should be avoided if, when and to the extent

possible; However, it is also important not to narrowly define self-interest since a person’s

interests include their social relationships that are closely related to their values and sense of

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self.105 The patient has a right to take their social context into consideration when making

decisions about their treatment.

The patient also has the right to waive consent if they desire to do so. This is morally

acceptable because a properly given consent waiver maintains the values of self-determination,

placing the patient as the ultimate decision-maker and letting them decide if they will experience

harm resulting from disclosure, such as anxiety from the decision process.106 The patient can

delegate decision-making process to a proxy if they wish to do so. Not all patients have the same

decision-making preferences. Some patients do not want to make their own or prefer to entrust

decision-making to others for reasons such as the emotional, intellectual and physical weakness

from being sick and psychological barriers to understanding.107

A patient may choose to delegate decision-making for their care even when are

competent to make their own decisions. If a patient is not competent to make decisions, then

someone will be chosen to make decisions for them as well. This necessitates the role of a

surrogate decision-maker.

The role of the surrogate is to make decisions for the patient if he or she is unable to

make decisions for him or herself. The role of the surrogate becomes necessary if the patient

does not have or loses capacity to make decisions. Incapacity can be determined by the patient’s

health care team, specifically their physician. Capacity is most commonly determined by the

attending physician, and can be related to patient characteristics such as intoxication,

developmental disability, dementia, psychosis, or anything that would not render a patient unable

to understand or make rational decisions.108 The patient can be temporarily or permanently

unable to make health care decisions.

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In addition, the patient could be incapable of making certain decisions about their health

care, but able to make other decisions. The process of determining competence should include

defining what is meant by incompetent patient, and who should make decisions for patient if they

are incompetent so that, at a minimum, the goals of informed consent can be pursued on their

behalf.109 This can be a complex task, because the continuum of decision making capacity is

multifactorial, including the degree to which a patient can engage in discussions, understand

pertinent information, appreciate relevance of information, and use reasoning to make and

communicate a choice that is consistent with their values and goals.110

The process of determining competence begins with the informed consent process.

Competence can only be determined once consent and disclosure process has begun since it

requires that a patient must be able to make and communicate a decision, understand the factual

basis for their decision, appreciate the nature and consequences of treatment, process information

logically.111 Only when the patient begins engaging in this decision-making canheir capacity can

be assessed.

Health care providers should look for evidence of a patient’s incapacity, whether the

patient is mentally capable to make decisions, whether they are legally competent, whether they

have capacity to refuse and consent to care, if they have the ability to understand relevant

information, can appreciate consequences of the proposed course of action, and can

communicate a rational choice in accordance with their values.112 Organizational policy should

clearly outline the process for determining capacity of a patient. A patient’s level of competence

determines moral authorization for health care decisions and moral validity of consent based on

the patient’s ability to exercise autonomy in processing and understanding information, weighing

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consequences, applying values, making consistent decisions over time, and communicating

preferences.113

If a patient is incapacitated, it should be determined whether they have expressed prior

preferences through advanced planning – including establishing a durable power of attorney for

health care or an advanced directive – and if they need a surrogate, who would be the appropriate

surrogate to make decisions for the patient who can make a substituted judgement for the

patient.114 If a patient has freely and clearly expressed their wishes previously, these should be

honored if and when possible. It is especially useful if the patient has documented an advance

directive and/or who should be their surrogate, though wishes that were expressed in advance of

serious illness have limits since these decisions made may not have been informed, patients can

change their minds, directives can be open to interpretation, and expressed wishes may conflict

with patient’s best interest.115

When a patient has not previously expressed their wishes, health care providers should

avoid purely paternalistic approaches and consider what is known about patient’s wishes, what

can be inferred about patient’s wishes and what is the best interest of the patient.116 A patient’s

autonomy should be maintained to the degree possible by making judgments about what the

patient would have wanted for him or herself. This can be performed through a surrogate

decision-maker.

Surrogates – whether court-appointed guardians, non-relatives selected by the patient, or

family members – can be problematic when there are emotional barriers to decisions, decisions

made are inconsistent with the patient’s values, there are conflicts of interests, and when there

are disagreements among potential surrogates.117 Nevertheless, a surrogate is the best tool that

health care providers have to provide information and guide decisions based on the patient’s

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values. Surrogate decision-making using substituted judgment is solution that is closest to

maintaining the patient’s autonomy.

A surrogate should avoid bias and use substituted judgement, taking the place of the

patient in the informed consent process through collaborative decision-making with physician

while placing the patient’s values, goals and preferences into the decision-making process to the

extent possible and attempting to replicate the decision that the patient would have made for

themselves.118 The surrogate should decide as though he or she was the patient with the

information that is available about the patient’s values, beliefs and goals. The surrogate acts as

the patient in the shared decision-making process when the patient is not able to participate him

or herself.

When conflicts or ethical dilemmas arise from the individuals directly involved in the

shared decision-making process, ethics committees can help to mediate decisions through ethics

consultation.

4bii Addressing Social Determinants of Health through Organizational Policy focused on Shared Decision-Making

Shared decision-making as supported by organizational policy can reduce health

disparities related to social determinates of health. Informed consent and ethics consultation can

help to alleviate disparities caused by social determinants of health. Coercion is not always overt,

and instead is often structural, meaning that societal, cultural, economic and/or political realities

can make it so that an individual can only realistically make only possible choice.119 Shared

decision-making can be used to alleviate some of these structural barriers and support the patient

in making decisions based on his or her values, beliefs and goals for care. This includes

socioeconomic status, race, ethnicity, culture, language and geographic barriers to health.

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Socioeconomic Status, Race, Ethnicity, Culture and Language

Patients are influenced by risks and resources in their physical and social environments

often related to multiple dimensions of race, ethnicity and socioeconomic status, which combine

and accumulate to influence health outcomes.120 Socioeconomic status is one dimension that

significantly affects a patient’s ability to effectively interact with the health care system. Patients

with a disadvantaged socioeconomic status tend to have worse outcomes compared to those in

more advantaged situations. For example, long term breast cancer survival outcomes could be

improved by targeting patients with low socioeconomic status.121

Through shared decision-making as carried out through the informed consent process and

ethics consultation, the burdens of health disparities related to disadvantaged socioeconomic

status can be ameliorated.

The mechanism of how socioeconomic status affects health outcomes is not definitive.

Interpersonal interactions and experiences, such as exposure to social dominance expressed by

others and perceptions of low relative status, may be one mechanism linking socioeconomic

status to poor health outcomes such as cardiovascular disease.122 Other possible causal links or

correlations between socioeconomic status and poor health comes may include education level

and ability to pay for health care services.

The informed consent process as part of shared decision-making can begin to address

some of the barriers to health related to socioeconomic status. Through the informed consent

process based on shared decision-making, health care providers can determine the gaps in the

patient’s needs to be addressed through their interaction with the health care system. Health care

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providers should recognize that those who face burdens of disadvantaged socioeconomic status

may face unique challenges compared to those with a more advantaged status.

Informed consent requires decisional capacity, disclosure and understanding of

information, voluntariness and clear communication of consent or refusal.123 Understanding and

voluntariness are key pieces of informed consent when addressing patients with disadvantaged

socioeconomic status. The informed consent process should be used to ensure that patients are

able to understand and voluntarily consent to treatment or care options regardless of their

socioeconomic status.

Ethics consultation can also help to address issues related to socioeconomic status and

shared decision-making.

When an ethical question requiring ethics consultation is presented, the patient’s

socioeconomic status and potential associated barriers should be considered as part of the

consultation process. This is aligned with the goals of ethics consultation, which are to clarify the

facts of a case, identify and analyze ethical uncertainty and conflict, and to build consensus

among stakeholders.124 Since the patient’s socioeconomic status can have such a significant

impact on these goals, the ethics committee or consultant should consider ways in which

socioeconomic status could be influencing the case. For example, social support systems could

have an influence on the patient’s beliefs, values and goals related to socioeconomic status.

Optimistic self-belief and social support could help to explain the considerable variation

in health across the socioeconomic continuum, meaning that some individuals and groups could

be more resilient based on psychological or social resources.125 Considering these factors during

an ethics consultation can help to facilitate shared decision-making among health care providers

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and patients since it can help with understanding of the context in which the patient is making

decisions.

Closely related to and often overlapping with socioeconomic status, race, ethnicity,

culture and language can also have a significant impact on the effectiveness of shared decision-

making in the health care setting.

Socioeconomic Status, Race, Ethnicity, Culture and Language

Race, ethnicity, culture and language can also have a significant impact on health

outcomes and shared decision-making. Although often intertwined with socioeconomic status,

race, ethnicity, culture and language present unique barriers to shared decision-making within the

health care setting. For example, a high socioeconomic position may not necessarily alleviate the

toxic effects of discrimination related to the psychosocial conditions and stresses tied to minority

status.126 These factors should be considered as presenting unique challenges to clinical ethics

and the shared decision-making process.

Race, ethnicity, culture and language can significantly influence a patient’s ability to

engage in the informed consent process. Therefore, informed consent needs to be addressed

within the context of culture, with a patient having the right to autonomously decide who will be

involved in decision-making related to their health.127 People with different cultural or ethnic

backgrounds may have different expectations or perceptions that affect their health-related

decisions and basic assumptions of informed consent may not be culturally relevant for some

individuals or groups, necessitating a culturally responsive process for decision-making.128

Shared decision-making can facilitate a culturally sensitive informed consent process via

organizational policy that allows for flexibility and cultural understanding within the process.

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Language barriers can also be addressed through shared decision-making and the

informed consent process. Addressing language barriers to informed consent is a crucial aspect

of shared decision-making and clinical ethics since a patient cannot begin to understand

treatment options, risks and benefits if they do not even understand the language in which the

information is presented. Patients with limited English proficiency have been shown to have low

rates of documented informed consent in the United States.129 Policy that provides the structure

for the informed consent process should take language proficiency into consideration and

provide support for patients who do need support related to language skills, up to and including

interpretation services. Interpreters are essential for patients who do not understand the language

of their physician. When no trained interpreter is available, serious communication problems

such as misinterpretation, inaccurate or incomplete information, and loss of privacy, can occur so

low cost strategies such as translating key documents into Spanish, testing and training clinicians

and staff for bilingual and interpretation skills, and training of how to effectively use interpreters,

scheduling extra time for consulting requiring interpretation should be implemented by health

care organizations whenever possible.130

Improving the informed consent process as based on shared decision-making is one way

to address health disparities related to race, ethnicity, culture and language. Ethics consultation

should also take these factors into consideration, supporting the goals of shared decision-making

Race, ethnicity, culture and language should be considered when performing ethics

consultation since these factors can strongly influence a patient’s understanding of key issues, as

well as thier values and goals of care. Although racial or ethnic difference do not necessarily

constitute cultural differences, not all conflicts between people of different cultures are cultural

conflicts, and some cultural differences are not obvious, cultural values, beliefs, and behaviors

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do often determine an individual’s reaction to illness and death.131 In order for ethics consultants

to make decisions based on the foundations of shared decision-making, these factors should be

considered when analyzing and making recommendations on any case.

Quality of life perceptions can be influenced by these factors as well. Quality of life, or

degree of satisfaction a person experiences with their own life, should be discussed between the

patient and physician to determine the most desirable and attainable outcome, how it can be

achieved, risks and disadvantages associated with each decision, and potential long-term

consequences.132 A person’s race, culture and ethnicity can significant influence their

perceptions of quality of life. Quality of life assessment raises questions about changes in

treatment plans, like foregoing life-sustaining treatment, and how to care for patients who face

severely or profoundly diminished quality of life.133 These decisions can be heavily influenced

by a patient’s background and current context.

In addition to socioeconomic status, race, ethnicity, culture and langue, a patient’s

physical location or proximity to accessing health care services can significantly affect their

ability to engage in shared decision-making.

Geographic Location and Access

The location in which a patient lives can significantly affect their ability to access health

care and engage in shared decision-making. This can be especially true for individuals and

groups who live in rural areas. Barriers to receiving health services in rural areas can include

lack of knowledge of available resources, cost of services, difficulty navigating the system,

difficulty finding qualified providers, and proximity to services.134 These factors can all

influence a patient’s ability to engage in shared decision-making.

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A patient’s geographical location can affect their access to health-related services as well.

For example, a neighborhood food environment can have a significant impact on health and

accessibility to healthy food can be affected by physical distance from food sources, personal

mobility, and environmental barriers such as safety concerns, and facilitators such availability of

public transit service.135 These factors influence health outcomes for groups and individuals in

disadvantaged geographic areas, including many rural areas. In addition, health care needs such

as housing and transportation can be affected by geographic location and availability of health

resources. For example, adults with multiple sclerosis, can face barriers to obtaining specialized

housing, transportation, and resources needed to manage their progressive and episodic illness.136

Socioeconomic factors could also act in concert with geographical barriers to health care

from both individual and neighborhood level factors.137 Informed consent and ethics consultation

solutions could help to alleviate some of these barriers to accessing health care and achieving

quality health outcomes through shared decision-making.

A patient’s ability to engage in the ongoing informed consent process can be significantly

affected by their geographic location. For example, if a patient has limited transportation to

access health services, they may not have continuous or consistent interactions with a health care

provider, even if they have a condition or disease that would benefit from consistent health

service access. This transportation vulnerability can occur when transportation is a barrier to

accessing ancillary services, including availability, accessibility, accommodation, affordability

and acceptability of transportation.138

Technology could help to alleviate some of these barriers to shared decision-making and

access to information. For example, online health communities could help to alleviate

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geographical health disparities by facilitating sharing, dissemination and creation of health

information between urban users (as net suppliers) and rural users (as net recipients.)139 Health

care organizations could incorporate the concept of information sharing via the internet to

improve the informed consent process for those who have difficulty physically accessing health

services.

New approaches to ethics consultation can also help to address geographical barriers to

health care access. For example, health care organizations can institute web-based consultation

system for rapid dissemination of cases, on-call team with a clinician and a non-clinician, adding

cases to secure ethics website with space for ethics committee comments and discussion,

allowing for timely participation from committee members at different locations.140 This could

help to provide consultation resources to patients who cannot access a hospital with a robust

ethics consultation service.

Health care organizations can alleviate the burdens caused by health disparities by

addressing social determinants of health, including socioeconomic status, race, ethnicity, culture,

language and geography. This can be accomplished through organizational policy supporting

shared decision-making, focused on two key features: informed consent and ethics consultation.

Informed consent is a process that supports autonomous decisions of patients, and ethics

consultation helps to address particularly difficult ethical conflicts.

Organizations, physicians, patients, surrogates, and ethics committees all have important

roles in practical applications of clinical ethics through shared decision-making. The

organizational role is to facilitate and provide structural support for these elements of clinical

ethics. According to the American College of Healthcare Executives, Health Care leaders have

moral obligations to professional codes, patients, the organization, employees, the community

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and society with the fundamental ethical objectives of creating an equitable, accessible, effective,

and efficient system that maintaining or enhancing quality of life, well-being, and dignity of

patients.141 Through effective organizational leadership support for shared decision-making,

patients can have improved outcomes with fewer disparities based on social factors.

1 Thompson, P. "Seeking Common Ground in a World of Ethical Pluralism: A Review Essay of Moral Acquaintances: Methodology in Bioethics by Kevin Wm. Wildes, S.J." HEC Forum 16, no. 2 (2004): 114‐119. 

2 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012. 103‐106  

3 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012. 137‐138  

4 Charlesworth, M. "Don't Blame the 'Bio'‐‐Blame the 'Ethics': Varieties of (Bio)Ethics and the Challenge of Pluralism." J Bioeth Inq 2, no. 1 (2005): 10‐7.  

5 Mbugua, K. "Respect for Cultural Diversity and the Empirical Turn in Bioethics: A Plea for Caution." J Med Ethics Hist Med 5 (2012): 1.  

6 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 1.  

7 Turner, L. "From the Local to the Global: Bioethics and the Concept of Culture." J Med Philos 30, no. 3 (2005): 305‐311.  

8 Fagan, A. "Challenging the Bioethical Application of the Autonomy Principle within Multicultural Societies." J Appl Philos 21, no. 1 (2004): 15‐31.  

9 Turner, L. "From the Local to the Global: Bioethics and the Concept of Culture." J Med Philos 30, no. 3 (2005): 312‐316. 

10 Bach, P. B., L. D. Cramer, J. L. Warren, and C. B. Begg. "Racial Differences in the Treatment of Early‐Stage Lung Cancer." N Engl J Med 341, no. 16 (1999): 1198‐205.  

11 Collins, Karen Scott, Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and K. Tenney. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey." 2002. 25‐34 

12 Burgess, Diana Jill, Megan Crowley‐Matoka, Sean Phelan, John F. Dovidio, Robert Kerns, Craig Roth, Somnath Saha, and Michelle van Ryn. "Patient Race and Physicians' Decisions to Prescribe Opioids for Chronic Low Back Pain." Social Science & Medicine 67, no. 11 (2008): 1852‐60.  

13 Blackhall, L. J., G. Frank, S. T. Murphy, V. Michel, J. M. Palmer, and S. P. Azen. "Ethnicity and Attitudes Towards Life Sustaining Technology." Soc Sci Med 48, no. 12 (1999): 1779‐89.  

14 American College of Physicians. "Racial and Ethnic Disparities in Health Care, Updated 2010." Philadelphia, 2010.  15 Shaw, B. A., K. McGeever, E. Vasquez, N. Agahi, and S. Fors. "Socioeconomic Inequalities in Health after Age 50: Are Health Risk Behaviors to Blame?". Soc Sci Med 101 (Jan 2014): 52‐60. 

16 Businelle, M. S., B. A. Mills, K. G. Chartier, D. E. Kendzor, J. M. Reingle, and K. Shuval. "Do Stressful Events Account for the Link between Socioeconomic Status and Mental Health?". J Public Health (Oxf) 36, no. 2 (Jun 2014): 205‐12. 

17 Green, M. J., and M. Benzeval. "The Development of Socioeconomic Inequalities in Anxiety and Depression Symptoms over the Lifecourse." Soc Psychiatry Psychiatr Epidemiol 48, no. 12 (Dec 2013): 1951‐61. 

18 Hernandez, E. M. "Provider and Patient Influences on the Formation of Socioeconomic Health Behavior Disparities among Pregnant Women." Soc Sci Med 82 (Apr 2013): 35‐42. 

19 van Ryn, M., and J. Burke. "The Effect of Patient Race and Socio‐Economic Status on Physicians' Perceptions of Patients." Soc Sci Med 50, no. 6 (2000): 813‐28.  

                                                            

Page 207: An Ethical Framework for Organizational Resource

 

199

                                                                                                                                                                                                20 Lynch, John, Smith George Davey, Marianne Hillemeier, Mary Shaw, and et al. "Income Inequality, the Psychosocial Environment, and Health: Comparisons of Wealthy Nations." The Lancet 358, no. 9277 (2001): 194‐200. 

21 Olson, Maren E, Douglas Diekema, Barbara A Elliott, and Colleen M Renier. "Impact of Income and Income Inequality on Infant Health Outcomes in the United States." Pediatrics 126, no. 6 (2010): 1165‐73. 

22 Braveman, P., and S. Gruskin. "Poverty, Equity, Human Rights and Health." Bull World Health Organ 81, no. 7 (2003): 539‐45. 

23 Levine, Mark A., Matthew K. Wynia, Paul M. Schyve, J. Russell Teagarden, David A. Fleming, Donohue Sharon King, J. Anderson Ron, James Sabin, and Ezekiel J. Emanuel. "Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform." The Hastings Center Report 37, no. 5 (2007): 14‐19. 

24 Washington, Donna L., Jacqueline Bowles, Somnath Saha, Carol R. Horowitz, Sandra MoodyAyers, Arleen F. Brown, Valerie E. Stone, Lisa A. Cooper, and Disparities in Health Task Force Writing group for the Society of General Internal Medicine. "Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare." Journal of General Internal Medicine 23, no. 5 (2008): 685‐91.  

25 Collins, Karen Scott, Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and K. Tenney. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey." 2002. 45‐48 

26 Collins, Karen Scott, Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and K. Tenney. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey." 2002. 35‐44 

27 Weinick, R. M., and N. A. Krauss. "Racial/Ethnic Differences in Children's Access to Care." Am J Public Health 90, no. 11 (2000): 1771‐4.  

28 Collins, Karen Scott, Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and K. Tenney. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey." 2002. 9‐20 

29 Fiscella, K., P. Franks, M. P. Doescher, and B. G. Saver. "Disparities in Health Care by Race, Ethnicity, and Language among the Insured: Findings from a National Sample." Med Care 40, no. 1 (2002): 52‐9.  

30 Barr, D. A., and S. F. Wanat. "Listening to Patients: Cultural and Linguistic Barriers to Health Care Access." Fam Med 37, no. 3 (Mar 2005): 199‐204. 

31 Oliver, A., and E. Mossialos. "Equity of Access to Health Care: Outlining the Foundations for Action." J Epidemiol Community Health 58, no. 8 (Aug 2004): 655‐8. 

32 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012. 139‐148 

33 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012. 107‐129 

34 Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012. 130‐136 

35 Thompson, P. "Seeking Common Ground in a World of Ethical Pluralism: A Review Essay of Moral Acquaintances: Methodology in Bioethics by Kevin Wm. Wildes, S.J." HEC Forum 16, no. 2 (2004): 120‐128. 

36 UN General Assembly, Universal Declaration of Human Rights, 10 December 1948, 217 A (III) 37 Schroeder, D., and E. Gefenas. "Vulnerability: Too Vague and Too Broad?" Camb Q Healthc Ethics 18, no. 2 (Apr 2009): 113‐21. 

38 Council for International Organizations of Medical Sciences (CIOMS) & World Health Organization (WHO) “International Ethical Guidelines for Biomedical Research Involving Human Subjects.” Geneva: 2002. 

39 Shi, Leiyu DrPH M. P. A. M. B. A., and Gregory D. PhD Stevens. "Vulnerability and Unmet Health Care Needs." [In English]. Journal of General Internal Medicine 20, no. 2 (Feb 2005): 148‐54. 

40 Rogers, W. A. "Evidence Based Medicine and Justice: A Framework for Looking at the Impact of Ebm Upon Vulnerable or Disadvantaged Groups." J Med Ethics 30, no. 2 (Apr 2004): 141‐5. 

41 Daniels, Norman, “Justice, Health and Health Care,” in Medicine and Social Justice: Essays on the Distribution of Health Care, edited by Rhodes, Rosamond et. al. Oxford: Oxford University Press, 2012: 17‐20. 

42 Gordon, J. S. "Global Ethics and Principlism." Kennedy Inst Ethics J 21, no. 3 (2011): 251‐253.  

Page 208: An Ethical Framework for Organizational Resource

 

200

                                                                                                                                                                                                43 Dekker, Sidney. Just Culture: Balancing Safety and Accountability. Burlington, VT: Ashgate Publishing Company, 2014:1‐10. 

44 Gruskin, S., and N. Daniels. "Process Is the Point: Justice and Human Rights: Priority Setting and Fair Deliberative Process." Am J Public Health 98, no. 9 (Sep 2008): 1573‐7. 

45 Turner, L. "Bioethics in a Multicultural World: Medicine and Morality in Pluralistic Settings." Health Care Anal 11, no. 2 (2003): 103‐104. 

46 Betancourt, Joseph R., Alexander R. Green, and J. Emilio Carrillo. "Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches." The Commonwealth Fund, 2002.  

47 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002:189‐198. 

48 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002:182‐188. 

49 Chin, J. L. "Culturally Competent Health Care." Public Health Reports 115, no. 1 (2000): 25‐33. 50 Like, Robert C. "Educating Clinicians About Cultural Competence and Disparities in Health and Health Care." Journal of Continuing Education in the Health Professions 31, no. 3 (2011): 196‐206.  

51 Frintner, M. P., F. S. Mendoza, B. P. Dreyer, W. L. Cull, and D. Laraque. "Resident CrossCultural Training, Satisfaction, and Preparedness." Acad Pediatr 13, no. 1 (2013): 65‐71.  

52 Weissman, J. S., J. Betancourt, E. G. Campbell, E. R. Park, M. Kim, B. Clarridge, D. Blumenthal, K. C. Lee, and A. W. Maina. "Resident Physicians' Preparedness to Provide Cross‐Cultural Care." JAMA 294, no. 9 (2005): 1058‐67. 

53 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002:199‐214. 

54 Sue, Derald Wing. "Multidimensional Facets of Cultural Competence." The Counseling Psychologist 29, no. 6 (2001): 790‐821.  

55 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 3. 

56 Anderson, L. M., S. C. Scrimshaw, M. T. Fullilove, J. E. Fielding, and J. Normand. "Culturally Competent Healthcare Systems. A Systematic Review." Am J Prev Med 24, no. 3 Suppl (2003): 68‐79.  

57 Brach, C., and I. Fraser. "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model." Med Care Res Rev 57 Suppl 1 (2000): 181‐184.  

58 Brach, C., and I. Fraser. "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model." Med Care Res Rev 57 Suppl 1 (2000): 185‐203. 

59 Narayan, Mary Curry. "Six Steps toward Cultural Competence: A Clinician’s Guide." Home Health Care Management & Practice 14, no. 1 (2001): 40‐48.  

60 Maier‐Lorentz, M. M. "Transcultural Nursing: Its Importance in Nursing Practice." J Cult Divers 15, no. 1 (2008): 37‐43.  

61 Berlin, Elois Ann, and William C. Fowkes. "A Teaching Framework for Cross‐Cultural Health Care—Application in Family Practice." Western Journal of Medicine 139, no. 6 (1983): 934‐38. 

62 Smith, W. R., J. R. Betancourt, M. K. Wynia, J. Bussey‐Jones, V. E. Stone, C. O. Phillips, A. Fernandez, E. Jacobs, and J. Bowles. "Recommendations for Teaching About Racial and Ethnic Disparities in Health and Health Care." Ann Intern Med 147, no. 9 (2007): 654‐65.  

63 U.S. Department of Health and Human Services. Think Cultural Health. Retrieved January 13, 2018. https://www.thinkculturalhealth.hhs.gov 

64 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 6. 

65 Saha, S., M. C. Beach, and L. A. Cooper. "Patient Centeredness, Cultural Competence and Healthcare Quality." J Natl Med Assoc 100, no. 11 (2008): 1275‐85.  

66 Durante, C. "Bioethics in a Pluralistic Society: Bioethical Methodology in Lieu of Moral Diversity." Med Health Care Philos 12, no. 1 (2009): 35‐47.  

67 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 181‐188. 

Page 209: An Ethical Framework for Organizational Resource

 

201

                                                                                                                                                                                                68 Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 189‐199. 

69 Tervalon, Melanie, and Jann Murray‐Garcia. "Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education." J Health Care Poor Underserved 9, no. 2 (1998): 117‐25.  

70 Carrillo, J. E., A. R. Green, and J. R. Betancourt. "Cross‐Cultural Primary Care: A Patient‐Based Approach." Ann Intern Med 130, no. 10 (1999): 829‐34.  

71 United States Department of Health and Human Services, Office of Minority Health. "National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining Clas Policy and Practice." Washington, 2013: 14‐20.  

72 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002, 35‐38  

73 Green, C. R., K. O. Anderson, T. A. Baker, L. C. Campbell, S. Decker, R. B. Fillingim, D. A. Kalauokalani, et al. "The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain." Pain Med 4, no. 3 (2003): 277‐94.  

74 Fiscella, K., P. Franks, M. R. Gold, and C. M. Clancy. "Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care." JAMA 283, no. 19 (2000): 2579‐ 84.  

75 LaVeist, T. A., D. Gaskin, and P. Richard. "The Economic Burden of Health Inequalities in the United States." 2009.  76 Brach, C., and I. Fraser. "Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case." Qual Manag Health Care 10, no. 4 (2002): 15‐28.  

77 Juckett, G. "Cross‐Cultural Medicine." Am Fam Physician 72, no. 11 (2005): 2267‐74. 78 Betancourt, Joseph R. "Improving Quality and Achieving Equity: The Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care." 2006.  

79 Goode, Tawara D., M. Clare Dunne, and Suzanne M. Bronheim. "The Evidence Base for Cultural and Linguistic Competency in Health Care." 2006.  

80 Lie, D. A., E. Lee‐Rey, A. Gomez, S. Bereknyei, and C. H. Braddock, 3rd. "Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research." J Gen Intern Med 26, no. 3 (2011): 317‐25.  

81 Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002:180‐181. 

82 Durante, C. "Bioethics in a Pluralistic Society: Bioethical Methodology in Lieu of Moral Diversity." [In eng]. Med Health Care Philos 12, no. 1 (Mar 2009): 41‐47. 

83 Fox, R. C., and J. P. Swazey. "Examining American Bioethics: Its Problems and Prospects." Camb Q Healthc Ethics 14, no. 4 (2005): 361‐73.  

84 Légaré, France, and Holly O. Witteman. "Shared Decision Making: Examining Key Elements and Barriers to Adoption into Routine Clinical Practice." Health Affairs 32, no. 2 (Feb 2013): 276‐84. 

85 Veroff, David, Amy Marr, and David E. Wennberg. "Enhanced Support for Shared Decision Making Reduced Costs of Care for Patients with Preference‐Sensitive Conditions." Health Affairs 32, no. 2 (Feb 2013): 285‐93.  

86 Frosch, Dominick L., Suepattra G. May, Katharine A. S. Rendle, Caroline Tietbohl, and Glyn Elwyn. "Authoritarian Physicians and Patients' Fear of Being Labeled 'Difficult' among Key Obstacles to Shared Decision Making." Health Affairs 31, no. 5 (May 2012): 1030‐8. 

87 Peek, Monica E., Shannon C. Wilson, Rita Gorawara‐bhat, Angela Odoms‐young, Michael T. Quinn, and Marshall H. Chin. "Barriers and Facilitators to Shared Decision‐Making among African‐Americans with Diabetes." Journal of General Internal Medicine 24, no. 10 (Oct 2009): 1135‐9. 

88 Grande, Stuart W., Marie‐anne Durand, Elliott S. Fisher, and Glyn Elwyn. "Physicians as Part of the Solution? Community‐Based Participatory Research as a Way to Get Shared Decision Making into Practice." Journal of General Internal Medicine 29, no. 1 (Jan 2014): 219‐22. 

89 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  1‐13 

90 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  15‐17 

91 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. New York: McGraw Hill Education: 51‐64. 

92 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 19‐26 

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                                                                                                                                                                                                93 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  168‐174 94 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  109‐112 95 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  53‐60 96 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  65‐70 97 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns 

Hopkins University Press. 2015 (2nd edition). 46‐53 98 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  175‐185 99 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 32‐39 100 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 52‐59 101 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  18‐21 102 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical 

Decisions in Clinical Medicine. New York: McGraw Hill Education: 47‐50. 103 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 77‐84 104 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  24‐26 105 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  32‐35 106 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  85‐90 107 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  27‐31 108 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  98‐99 109 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  94‐97 110 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 77‐83 111 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  100‐106 112 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical 

Decisions in Clinical Medicine. New York: McGraw Hill Education: 65‐80. 113 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns 

Hopkins University Press. 2015 (2nd edition). 17‐21 114 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical 

Decisions in Clinical Medicine. New York: McGraw Hill Education: 81‐89. 115 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 90‐97 116 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns 

Hopkins University Press. 2015 (2nd edition). 22‐26 117 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 104‐107 118 Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd 

Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.  113‐115 119 Fisher, Jill A. "Expanding the Frame of "Voluntariness" in Informed Consent: Structural Coercion and the Power of Social and 

Economic Context." Kennedy Institute of Ethics Journal 23, no. 4 (Dec 2013): 355‐79. 120 Williams, David R., Naomi Priest, and Norman B. Anderson. "Understanding Associations among Race, Socioeconomic Status, 

and Health: Patterns and Prospects." Health Psychology 35, no. 4 (2016): 407‐11 5p. 121 Keegan, Theresa H. M., Allison W. Kurian, Kathleen Gali, Tao Li, Daphne Y. Lichtensztajn, Dawn L. Hershman, Laurel A. Habel, 

Bette J. Caan, and Scarlett L. Gomez. "Research and Practice. Racial/Ethnic and Socioeconomic Differences in Short‐Term Breast Cancer Survival among Women in an Integrated Health System." American Journal of Public Health 105, no. 5 (2015): 938‐46. 

122 Cundiff, Jenny M., Timothy W. Smith, Carolynne E. Baron, and Bert N. Uchino. "Hierarchy and Health: Physiological Effects of Interpersonal Experiences Associated with Socioeconomic Position." Health Psychology 35, no. 4 (2016): 356‐65 11p. 

123 Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns Hopkins University Press. 2015 (2nd edition). 33‐39 

Page 211: An Ethical Framework for Organizational Resource

 

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                                                                                                                                                                                                124 Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013. 130‐131 125 Schollgen, Ina, Oliver Huxhold, Benjamin Schuz, and Clemens Tesch‐Romer. "Resources for Health: Differential Effects of 

Optimistic Self‐Beliefs and Social Support According to Socioeconomic Status." Health Psychology 30, no. 3 (2011): 326‐35 10p. 126 Molina, Kristine, and Yenisleidy Simon. "Everyday Discrimination and Chronic Health Conditions among Latinos: The 

Moderating Role of Socioeconomic Position." Journal of Behavioral Medicine 37, no. 5 (2014): 868‐80 13p. 127 Calloway, S. J. "The Effect of Culture on Beliefs Related to Autonomy and Informed Consent." Journal of Cultural Diversity 16, 

no. 2 (Summer 2009): 68‐70 3p. 128 Lakes, Kimberley D., Elaine Vaughan, Marissa Jones, Wylie Burke, Dean Baker, and James M. Swanson. "Diverse Perceptions of 

the Informed Consent Process: Implications for the Recruitment and Participation of Diverse Communities in the National Children's Study." American Journal of Community Psychology 49, no. 1‐2 (Mar 2012): 215‐32. 

129 Schenker, Yael, Frances Wang, Sarah Jane Selig, Rita Ng, and Alicia Fernandez. "The Impact of Language Barriers on Documentation of Informed Consent at a Hospital with on‐Site Interpreter Services." Journal of General Internal Medicine 22 (Nov 2007): 294‐9. 

130 Hunt, Linda M., and Katherine B. de Voogd. "Are Good Intentions Good Enough?: Informed Consent without Trained Interpreters." Journal of General Internal Medicine 22, no. 5 (May 2007): 598‐605. 

131 Perkins, Henry S. "Culture as a Useful Conceptual Tool in Clinical Ethics Consultation." Cambridge Quarterly of Healthcare Ethics 17, no. 2 (Apr 2008): 164‐72. 

132 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. New York: McGraw Hill Education: 109‐111. 

133 Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. New York: McGraw Hill Education: 126‐132. 

134 Solovieva, Tatiana I., and Richard T. Walls. "Barriers to Traumatic Brain Injury Services and Supports in Rural Setting." Journal of Rehabilitation 80, no. 4 (2014): 10‐18 9p. 

135 Bader, Michael D. M., Marnie Purciel, Paulette Yousefzadeh, and Kathryn M. Neckerman. "Disparities in Neighborhood Food Environments: Implications of Measurement Strategies." Economic Geography 86, no. 4 (2010): 409‐30. 

136 Roessler, Richard T., Malachy Bishop, Phillip D. Rumrill, Kathleen Sheppard‐Jones, Brittany Waletich, Veronica Umeasiegbu, and Lisa Bishop. "Specialized Housing and Transportation Needs of Adults with Multiple Sclerosis." Work 45, no. 2 (2013): 223‐35. 

137 Beard, J. R., N. Tomaska, A. Earnest, R. Summerhayes, and G. Morgan. "Influence of Socioeconomic and Cultural Factors on Rural Health." Australian Journal of Rural Health 17, no. 1 (2009): 10‐15 6p. 

138 Sagrestano, Lynda M., Joy Clay, Ruthbeth Finerman, Jennifer Gooch, and Melanie Rapino. "Transportation Vulnerability as a Barrier to Service Utilization for Hiv‐Positive Individuals." AIDS Care 26, no. 3 (2014): 314‐19 6p. 

139 Mein Goh, Jie, Guodong Gao, and Ritu Agarwal. "The Creation of Social Value: Can an Online Health Community Reduce Rural–Urban Health Disparities?". MIS Quarterly 40, no. 1 (2016): 247‐63. 

140 Smith, Lauren B. M. D., and Andrew D. O. M. P. H. Barnosky. "Web‐Based Clinical Ethics Consultation: A Model for Hospital‐Based Practice." Physician Executive 37, no. 6 (Nov/Dec 2011): 62‐4. 

141 American College of Healthcare Executives. ACHE Code of Ethics. November 14, 2011. https://www.ache.org/abt_ache/code.cfm#organization 

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Chapter 5: Medical Futility and Rationing Health care resources are finite, yet demand for needed health resources are virtually unlimited.

This means that some people will not be afforded the resources for the care they need. In the

United States, the highly politicized, often ill-informed debate about health care rationing has

prevented proper critical analysis of health care resource distribution. With little guidance from

federal or state governments on health care resource allocation, health care delivery

organizations are left to determine how these limited resources can be distributed to patients in

an ethically sound and/or efficient way.

In the past, the basis for discourse surrounding health care delivery resource allocation

has focused on two key concepts: medical futility and rationing. These two key concepts will be

examined as background concepts for ethical resource allocation at the level of health care

delivery. Resource allocation will then be explained as a concept which transcends the existing

understandings of futility and rationing. Based on obligations to protect and promote the human

right to quality health care, health care organizations have an obligation to develop ethically

sound ways to distribute their limited resources. These decisions should be founded in justice,

and should not be influenced by non-medically relevant patient characteristics such as race,

ethnicity, culture, socioeconomic status and geographical proximity to health care providers.

5a Medical Futility

Futile medical care can be defined as a treatment or medical intervention where there is no

benefit, or where the amount of benefit achieved is judged as not worth its costs. When

unpacking this broad definition, however, flaws with applications for the medical futility concept

emerge. Ambiguity remains in terms of which expected outcomes are relevant and how likely

those outcomes are to occur. This can lead to drastic differences in opinion among stakeholders

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making assessments based on different assumptions of risk and outcomes. In addition, the

acceptable probability threshold for achieving the patient’s goals has not met consensus. These

factors can lead to equity violations when medical futility disagreements are influenced by bias,

especially when these biases are related to social determinants of health. Opinions of futility are

susceptible to opinions on whether specific patients are worth of a perceived high-cost, low-

benefit treatment. When these judgements are made based on any non-medically relevant

criteria, they unjustified and in violation of the right to quality health care.

5 ai Defining Medical Futility

The purpose of medical futility assessment is to determine the probability of achieving desired

outcomes from a medical intervention, then possibly limiting or eliminating the intervention

based on this assessment. While the virtue of this type of assessment may be rational on some

level, there are many arguments against the use of medical futility as assessment criteria for

patient interventions. First and foremost, there is no established normative criteria or threshold to

determine how to limit treatment for the critically ill or to determine medical futility.1 With no

normative criteria or commonly accepted guidelines for judging where medical care reaches the

level of futility, variation and ethical concerns of bias are introduced into this concept.

While specific normative criteria has not been established for medical futility assessment,

relevant ethical principles have been identified. These principles include the equivalence of

withholding and withdrawing life support, the difference between killing and letting someone

die, the distinction of medication intention to hasten death versus palliate, and the ethics of care

or requirement to not only treat for longevity, but also alleviate the suffering of patients and

families.2 Clarifying these principles may assist in medical futility assessment, although thus far

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they have not been enough to develop a commonly accepted normative criteria for medical

futility.

Since there are no commonly accepted guidelines for determining medical futility, the

U.S. federal government has not instituted policy to support decision-making or how to manage

resources when treatment may be futile. Institutional policy developed within the health care

delivery organization is thus left to guide this decision making both systematically and at the

bedside on a case-by-case basis. Specifically, institutional policy should be put in place to

support clear communication, protecting both patient and professional autonomy and addressing

the emotional obstacles of medical decision-making.3 Incorporating communication and

organizational culture that facilitates the patient-physician relationship should be at the core of

this institutional policy and have special expediency when limited resources are involved. For

example, blood products are a valuable resource that should be used judiciously and only when

there is a clear connection to achieving the goals medicine.4 Institutional policy that guides

evidence-based decision-making and communication between providers and patients about blood

products can be put in place to protect this limited resource. Additionally, institutional policy can

support providers and patients to make shared decisions when the decision does not fit into the

mold of the general policy. Institutional policy can address conflicts in decision-making that

arise between patient autonomy and the authority of clinical experts by providing rules for the

decision-making process governing a range of situations and promoting shared decision-

making.5 This policy should focus on the roles of the patient or surrogate, the provider, and the

ethics committee.

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The Role of the Patient or Surrogate

The role of the patient or surrogate is to provide the values and goals related to the treatment

option. When it appears that a treatment may be deemed "medically futile," the provider and

patient (or surrogate) will discuss options based on the patient’s values and preferences. These

options should allow for consideration of the patient’s values, priorities, life philosophy and

background, which can significantly influence their decision-making process.6 The provider

should enourage this shared decision-making that includes the patient’s values and goals.

To engage in this decision-making process, the patient must first understand the key

variables for an informed decision. The patient must then take this understanding and relate it to

their values, beliefs and goals with relevance to the decision. Patient education is an essential

component of this informed decision-making, and can be aided by decision-making tools as well

as the provider’s awareness of personal views and biases.7 A patient must be informed of all

information relevant to the decision without bias. Institutional policy should be developed to

facilitate this patient education and encourage shared decision-making. This type of shared

decision-making may also be called "personalized patient activation and empowerment," which

can be used to aid with decision-making through involvement of health care providers, the

community and the delivery system to provide knowledge, self-determination and confidence to

patient decision-making to improve health and reduce health disparities.8 The patient must be

empowered with an understanding of how all relevant information relates to their values and

goals in order to self-determine. Only through an understanding of this relationship between

goals and relevant clinical information can an assessment of medical futility even begin to form.

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Institutional policy to support this shared decision-making and patient education is

especially important to overcome barriers to physician-patient communication. One of the major

barriers of this communication involves the power dynamic between physicians and patients.

The dynamic between patient autonomy and physician authority can create challenges for

identifying appropriate treatment and a shared understanding of prognosis.9 Although this

challenge prevails within most health care delivery organizations, it can be overcome through

organizational interventions. For example, the communication conflicts created by the power

imbalance between the doctor and the patient can be systematically addressed by using a

decision-making matrix including the initial state, the defined intervention, the defined goal of

treatment over time, how much gain there will be in net benefit for each treatment, and a

declaration of the defined goal in relation to the intervention.10 Frameworks and tools for

decision-making, developed and implemented at the level of the delivery system, can begin to

address the barriers to physician-patient communication and decision-making related to medical

futility. Also, these decision-making tools should account for the complicated relationship

between autonomy and well-being. Due to a lack of stable preferences and/or decision-making

biases, patients do not always make decisions in their best interests.11 Decision-making and

communication tools should incorporate ways to address this potential conflict between

respecting a patient’s autonomy and supporting their well-being.

The involvement of family and surrogate decision-makers should also be included in

these organizational models, frameworks and policy for shared decision-making. Some patients

may value family involvement and input in decisions about whether care is futile in relation to

their goals of care. In some cases, relational autonomy – rather than traditional autonomy models

– may be appropriate when patients value family involvement in decision-making.12

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Incorporating the potential for varying patient perspectives in medical decision-making will be

essential for ethical organizational policy formation and implementation related to medical

futility. In addition, the role of surrogates must be addressed for ethical decision-making related

to medical futility. Surrogates decision-making is difficult and unique since the surrogate is

presuming what the patient would have wanted, or what would be best for the patient. In

addition, surrogates tend to have overly optimistic expectations and there can be barriers to

quality end-of-life care - such as more invasive treatments and delayed palliative care integration

– when surrogates midjudge prognosis of the patient.13 Providers need the ability to work with

surrogates and facilitate their unique informed decision-making process. Importantly, providers

should help surrogates separate their own beliefs versus the values and beliefs that the patient

would have in the present situation. For example, religious influences can not only impact a

patient’s medical decision-making, but surrogates also often invoke their own religious beliefs

related to the value of life, religious coping and support, and guidance of their religious

community.14 Organizational policy should support this and other unique aspects of surrogate

decision-making. Overall, physicians may be able to better understand patients and surrogates,

including how they make medical decisions, by discussion religious and spiritual ideas of the

patient and their family.15 Physicians need the tools and support from the health care delivery

organization to understand and address these needs.

The Role of the Health Care Provider

In medical futility assessments, the role of the health care provider is to clarify the goals of care,

give patients and families time to comprehend the diagnosis and options, and facilitate patient

and family expressions of understanding. The health care provider must accomplish this while

demonstrating professional integrity, incorporating professional norms and standards into

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communication and the shared decision-making process. In cases of medical futility, physicians

should assess whether all reasonable options have been attempted and establish guidelines plus

limits for interventions in place. To accomplish this, physicians need to understand the limits of

medical care and their own power. In addition, physicians should avoid offering medically

inappropriate options while also addressing the emotional needs of patients.

Health care providers can face many challenges when assessing and communicating

about medical futility. Challenges to discussions and determinations about nonbeneficial include

differences in prognostic estimates, inadequate data about quality of life, unprepared patients,

variation in perception of the role of palliative care, inconsistency in weighing patient goals, and

time constraints.16 The uncertainties of these decisions creates major barriers to effectively

assessing and communicating about potentially medically futile care. The uncertainty inherent to

medicine can affect both quantitative and qualitative assessments of treatment benefits.17 This

uncertainty can affect quantitative risk assessments as well as quality of life predictions for the

patient. This uncertainty is the crux of ethical dilemmas related to medical futility.

Some health care providers are better at assessing and predicting patient benefits of care

than others. With more experience, physicians can make better decisions about treatment

appropriateness and engage in better communication for decision-making.18 More experienced

physicians tend to make better decisions when faced with uncertainties and complexities than

those who have less experience. Physician trainees can experience moral distress when asked to

provide treatments that they believe to be futile which can lead to decreased job satisfaction,

feelings of powerlessness, compromised well-being, burnout, and thoughts of quitting.19 Those

who experience internal ethical conflict and self-doubt over medical futility assessments can

experience negative consequences for themselves as providers. It is important for leaders of

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health care delivery organizations to recognize this and address barriers and challenges to

decision-making faced by junior or trainee health care providers.

In addition, health care delivery organization policy, leadership and culture should

facilitate healthy responses to the uncertainty of medicine. Physicians should learn to recognize

and tolerate uncertainty and avoid overconfidence to improve the quality of information they

provide to patients and promote informed decisions.20 In respect to patient autonomy and

informed consent, patients should know the level of certainty of various potential outcomes of

treatment or non-treatment. If there is uncertainty or lack of evidence, the physician should use

professional judgement to facilitate shared decision-making emphasizing patient autonomy.21

Patients should be able to consider all relevant information to decision-making, including

probabilities or uncertainties of an outcome occurring.

While providers are not obligated to offer non-beneficial treatment to patients,

they should always offer some option to care for the patient. In many cases the best option for

patient care may be palliative care. Providers who deny non-beneficial treatment should still

provide palliative care as an alternative and give the patient the opportunity to contact other

practitioner or institution.22 Provider transparency as to what treatment options are available,

their probability, the level of uncertainty in outcomes, and what may be offered by other

providers is all part of the ethical respect for patient autonomy and respect for a patient’s

personal integrity. In addition, physicians should have a commitment to trustworthiness, showing

attitudes and behaviors that gain the patient and family’s trust.23 The relationship that the

physician cultivates with the patient is essential for smooth and morally sound shared decision-

making about a patient’s care. Health care delivery organizations can help to facilitate this

decision-making by creating an organizational culture and policy that supports transparent,

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compassionate, and respectful communication between the provider and the patient. Patient-

physician interaction can be improved through more open communication and a mutual

recognition of topics where there is no clear and present expert on the matter.24 Health care

delivery organizations can help physicians to recognize topics and situations where there may be

a high level of uncertainty. In addition, organizations can help physicians to develop cultural

competency and understanding of potentially diverse patient perspectives on medical decision-

making. This can help the provider to understand the patient’s values and goals of treatment. For

example, an understanding of patients’ and families’ religious beliefs can help a physician to

better understand the patient perspective, including their values and preferences.25 The provider

should recognize the diverse perspectives and experiences of the patient that will affect their

goals of care, and thus help determine whether a treatment option is futile in terms of the

patient’s goals. In addition, the provider should use introspection to analyze how their own

background, values and biases may affect decision-making with the patients. In other words, a

physician should consider their personal views versus professional norms.26 A physician should

understand which opinions on the best course of action for the patient come from their own,

potentially biased, beliefs versus evidence-based medical management and professional values.

Organizational policy and provider decision-making can use approaches and innovations

of patient-centered care to achieve effective shared decision-making. Health care delivery

organizations have a significant role in facilitating these interactions since patient-centered care

innovations depend on leadership development, incentives for experimentation, and cooperation

between delivery systems, health plans and policymakers.27 This leadership development and

cooperation will depend on programs and policies at the health care delivery organization. This

is especially important in the United States as the population continues to become increasingly

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diverse, creating serious challenges for health care administrative leaders and providers. Because

of this, health care organizational policy needs to balance of homogenization (building common

ground) and customization (addressing individual uniqueness) to adequately address diverse

patient populations.28 In addition, recognizing this common ground as well as the unique needs

of patients will be essential for conflict resolution in medical decision-making. When

disagreement occurs between a provider and patient, or any stakeholders in the patient’s care,

other support may be needed to make an ethically sound conclusion to address the uncertainty.

Decisions about medically futile care should not be unilateral and instead be based on a

foundation of rapport and trust between the physical and patient with mediation from outsiders

such as ethics committees when needed.29 Even provider-patient communication is effective and

the patient’s autonomy is fully respected, there still may be disagreement or conflict between the

provider and patient.

Institutional policy and provider decision-making may also consider the costs of futile

care toward other patients that they serve. Providing futile care - or care to prolong life without

achieving meaningful benefit to the patient - is associated with delays in care to other patients.30

Therefore, balancing the spread of resources is an associated outcome of medical futility

assessment. When resources are used to give treatments not aligned with the patient’s goals of

care, other patients who would benefit from the treatment may lose out on the resource. Medical

futility may then be useful as a starting point or foundational concept for a resource allocation

framework to emerge.

aii Social Determinants of Health - Bias & Influence on Futility Assessments Social determinates of health can further complicate the ethical application of medical futility

concepts, especially if related bias is introduced into medical futility assessment. Justice should

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form the foundation for ethical futility assessment to prevent undue bias from influencing

futility-related decisions. When conflict arises in futility assessment, ethics committees can

mediate problems at the beside. Ethics committees can also preemptively identify potential

biases through the development of ethically sound organizational policy related to medical

futility assessment.

Justice

Justice in terms of modern ethical discourse, is "the moral principle that relates to proper

'balance' or allotment among persons of groups.”31 Justice then explains how to incorporate

fairness into resource allocation within health care organizations. Justice creates a foundation for

ethical distributions of benefits and burdens.32 Incorporating solidarity into justice-based analysis

of organizational policy can help to elucidates key concepts related to fairness in health care.

Solidarity can provide important relational aspects that can complement rights-based justice

approaches to health care by promoting a sense of belonging, recognition, reciprocity and

support.33 Solidarity supports justice, and justice supports the human right to health. The right to

health includes the right to pursue flourishing where one can make sense of oneself and one’s

own identity including one’s past, present, and future, and the ability to act in accord with one's

own nature.34 This includes the rights of all persons, regardless of their culture, religion,

ethnicity, race, gender, or age. All persons have a right to justice in support of the human right to

quality health care.

In practice, this right can be difficult to carry out when policy leaders and health care

providers hold personal biases. Even physicians face limitations in decision-making that may be

influenced by either implicit or explicit bias. Limitations of cognitive capacity can lead

physicians to make systematic errors in judgement, such as estimation of subjective, rather than

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statistical, probabilities related to diagnostic decision-making, based on a patient’s belonging to a

minority group.35 These limitations can place unjust burden on marginalized individuals who are

the subject of this biased decision-making. A health care professional has the same level of

implicit bias as the general population which can impact the clinician-patient interaction and lead

to biased treatment, level of care, and diagnosis decisions.36 When bias is introduced during the

clinician-patient interaction, there is a potential for serious, negative consequences for

marginalized individuals and groups. Racism, ageism, and sexism are just a few examples of

how this bias can manifest into unjust treatment of patients.

Structural racism can have a serious negative impact on health outcomes for those

afflicted. Structural racism is manifested in economic injustice and social deprivation,

environmental and occupational inequalities, psychosocial trauma, targeted marketing of health-

harming substances, inadequate health care, state-sanctioned violence and alienation from

property and traditional lands, political exclusion, maladaptive coping behaviors and stereotype

threats.37 This means that, even beyond the physician-patient interaction, patients face

discrimination and bias that can put them behind in terms of health outcomes. For example,

structural racism, especially that which results from inequalities in education, professional

opportunity, and income, is correlated with an African-American infant mortality rate that is

double than that of white Americans.38 There are a litany of negative outcomes like this that are

the result of this structural racism. When making decisions about medical care, and especially

about futility of care, providers and organizational policy should ensure that structural racism is

not causing unjust harm toward minority patients.

Ageism is another way in which bias may manifest itself in medical decision-making.

Ageism involves bigotry and discrimination from one age group to another, and is embedded in

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social cognition and prejudice in a variety of fields – including health care.39 Ageism has many

implications for health care decision-making. Ageism can impact autonomy in health care

decision-making, especially in terms of its impact on an individual’s self relations, including

one’s self-worth, self-esteem and self-trust.40 A patient may internalize ageism when facing

systematic unfair treatment. This can ultimately affect the patient’s capacity to make autonomous

decisions and participate in shared decision-making.

Gender is another area where bias may occur in medical decision-making. Gender

inequality exists in health care access, where there is a gender bias that negatively impacts

females in both clinical practice and research.41 This demonstrates that root of bias can go even

deeper than bedside interactions and result from structural inequalities such as unbiased inclusion

in medical research.

Provider bias does not always have to be based on demographics, and can also be based

on certain clinical conditions. For example, negative attitudes held toward overweight and obese

patients include blaming the patient for their weight, disrespectful treatment, inappropriate

treatment and, in health care, can lead to less empathetic communication from providers.42 This

type of bias toward overweight patients can lead to negative health consequences for patients and

create barriers to effective shared decision-making.

These types of bias and discrimination - racism, ageism, sexism and others - can act

independently but also can be compounded when a patient falls into multiple marginalized

groups. Bias can also be intersectional, where multiple patient factors impact the bias of a health

care provider. For example, gendered racism and its related microaggressions can negatively

impact the mental and physical health outcomes of black women.43 This and other types of bias

and discrimination can be either conscious or unconscious.

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Health care delivery organizations can create policies that address both conscious and

unconscious biases. Health disparities that result from implicit bias of providers can be mitigated

by experience and expertise.44 Institutional policy that promotes experience and knowledge about

treating marginalized groups can help to mitigate implicit bias. Explicit bias can be addressed

more directly through training and management techniques. Provider education should focus on

self-awareness of cognitive, emotional end ethical responses to uncertainty and using decision

aids or diagnostic guidelines to assist with decision-making.45 Creating a systematic framework

and tools for decision-making can reduce or eliminate bias by creating a fair process for all

patients.

Leaders of health care delivery organizations should use caution, however, when

removing too much physician autonomy in decision-making. Bias can also occur when

physicians over-rely on clinical decision-support. This type of bias can lead to omission when

clinicians do not find errors when they do not receive an alert and commission bias when

clinicians do not verify the veracity of an alert before acting.46 Organizational policy should

focus on making ethical decision-making easy and create barriers to biased, unethical decision-

making. Removing bias from decision-making related to futility assessment is especially

imperative due to the potential for grave, life-or-death consequences in medical futility cases.

Bias or unequitable treatment related to medical futility decisions opens the possibility for gross

injustice.

The Role of Ethics Committees

Ethics consultation developed as the complexity of modern medicine advanced, including the

development of organ replacement therapy and life-prolonging measures in the ICU, due to the

need for shared responsibility for difficult decisions, support for physicians, and difficulty in

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bedside decision-making.47 The ethical complexity of modern medicine has created a need for

ethics committee intervention on both bedside and policy decision-making.

The roles and obligations of ethicists and ethics committees include creating and updating

organizational code of ethics, enforcing professional conduct, anticipating and addressing ethical

issues from scientific developments, contributing to public discourse, conducting ethics research,

producing or contributing to policy statements of the organization, and providing education and

training.48 Ethics committees can identify biases related to social determinants of health when

facilitating medical futility discussions by focusing the ethical dimensions and clinically relevant

information of the decision-making process. Ethics committees also play a crucial role in clinical

guideline development, policy advisement, and case review.

Ethics committees should be trained in identifying both explicit and unspoken, implicit

bias in health care decision-making. Including representation from marginalized groups could

help to alleviate distrust of the decision-making process, as well as improve understanding of the

burdens and benefits that each unique patient may be facing.49 Eliminating unfair decision-

making bias at both the organizational policy level and at the bedside is a crucial role of the

ethics committee.

Ethics committees should also be versed in resource scarcity and the balance between

individual and population health outcomes. Ethics committees can help providers to focus on the

long-term risks of a procedure, including potential psychosocial conditions, and guide the

provider and patient to comprehend the suffering and the dying process. This can be

accomplished through either an individual consult or committee consultation. Individual ethics

consultation may afford better greater of access, speed, flexibility, convenience, and trust

building, while ethics committee consultation can offer diverse perspectives, multiple approaches

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and opinions, enriched ethical deliberation, and complementary qualifications.50 Depending on

the situation and decision support needed, either of these approaches could alleviate the ethical

concerns presented by an ethically ambiguous case. In either case, the role of ethics consultation

is to mediate the process of decision-making. Physicians may tend to expect help with moral

distress, avoiding legal consequences, and mediation rather than prescriptive solutions from

ethics committees.51 Rather than offering a conclusive solution, the ethics consultation can assist

the provider and patient in communication and in the understanding of ethically relevant

information for the decision.

Ethics committees must also navigate through multidisciplinary interactions that may

complicate the decision-making process. Different care providers may interact with ethics

committees differently, so ethics committees should consider the nuances of multidisciplinary

interactions within the care team to improve structured support for the decision-making

process.52 The ethics committee can facilitate understanding not only between provider and

patient but between different types of care providers and provider of differing disciplines. In

addition, ethics committees may create stronger relationships with providers by providing

support to their personal struggles with ethical decision-making. Ethics Committees can engage

in moral distress consultation when healthcare professionals are feeling loss of power and

perception of compromising their own moral integrity.53 This can help to build a relationship of

trust and understanding between health care providers and ethics committees.

Ultimately, the ethics committee can help to facilitate both policy and individual

consultation that emphasizes medically relevant information in decision-making and addresses

the potential for both explicit and implicit bias in decision-making.

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5b Resource Allocation versus Rationing in Health Care

Medical futility is often incorporated into the health care resource allocation assessment when

expensive, non-beneficial interventions create high costs to the health care system. Using

resources on non-beneficial treatment means that the same resource is not available for another

patient who may benefit. When applied through a lens respect for human vulnerability and social

responsibility and when carried out through ethically sound policies and processes, the

incorporation of medical futility assessment to health care resource allocation can be justified.

This must be differentiated than health care rationing, however, since rationing relies on

potentially unjust, inadaptable criteria for determining who gets critical health care resources. A

systematic organizational resource allocation framework, however, could adapt to specific

patient situations and patient characteristics (including social determinants of health.)

Importantly, ethical resource allocation includes considerations for quality of care, patient safety,

cultural competence, and shared decision-making. With quality care equitably maximized,

human rights will be protected and health care delivery will be ethically grounded.

5bi Rationing

Rationing is based on specific patient characteristics, or group characteristics of patients

that are in similar situations. This type of rationing can only be justified when applied to very

specific situations in very specific contexts, while overarching judgements applied across types

of care are impossible to uniformly justify.

Justifications for Rationing in Health Care

Due to the reality of limited health care resources, justification for systematic rationing of

health care has been attempted, albeit in ways that have been strongly contested. Models for

rationing care have been developed based on age, disease, treatment, waste, autonomy,

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effectiveness, personal responsibility, personal choice, individual behavior and luck but none

have reached any overarching agreement.54 Arguments have been made for these and other

criteria with little if any movement toward consensus on how to ration in the United States. For

example, age has been used justify rationing in health care, such as the fair innings distributive

principle based on age, with a central focus on maximizing life years.55 Though arguments have

been made for this approach to rationing, policy in the U.S. has not embraced rationing by age.

Other examples of approaches to rationing have similarly lacked consensus in the United States.

Rationing can occur both at the policy level and at the bedside. Some specific examples

of rationing have been embraced in very specific contexts, although an overarching approach to

rationing remains elusive. An example of a context-specific approach to rationing is the

management of antimicrobial therapy. Antimicrobial therapy is a beneficial treatment that can be

held from an ICU patient in order to protect the outcome of the critically ill population in

general.56 This is an example of rationing that has been accepted in the United States in a very

specific context.

A major ethical conflict of rationing is the ethical obligation to the individual patient

versus the patient population. Physicians may feel conflict between their fidelity to their

individual patient and responsibility toward patients apart from their immediate experience,

especially when the chance of a good outcome for their patient is unreasonably small compared

to their chance of prolonged suffering and death.57 Physicians face distress when making these

decisions on an individual basis, rather than within the context of policy and structure to support

ethical resource allocation.

Delimitation between rationing and ethical resource allocation can be a fine line when

facing certain rationing criteria. The difference between ethical resource allocation and unethical

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rationing is related to the rationing approach. An example of this fine line is risk and clinical

benefit in resource allocation decisions. This type of resource allocation approach would result in

decisions such as refusing elective surgeries for patients who smoke or are obese due to evidence

that connects these factors with perioperative complications.58 While similar to rationing, this

approach is not fully aligned with traditional rationing as it incorporates the benefit of the patient

who is being denied the treatment. When a patient will have a worse outcome based on a

behavioral issue that they are able to change, the benefit of withholding treatment until the

behavioral issue is fixed can be a justified reason for treatment delay. A secondary benefit to this

type of decision would be to re-allocate resources to patients who would have a greater

immediate benefit. Once the patient with the behavioral barrier to treatment addresses their

behavioral issue, they will receive the benefit. This speaks to prioritizing resources, or ethical

resource allocation, versus rationing resources.

Another ethical concern with rationing is the use of rationing when there remains a large

amount of inefficiency and waste in the health care system. When resources are being wasted on

non-beneficial care, it is difficult to justify rationing beneficial care. This means that an ethical

approach to the rationing debate may include parallel efforts to address inefficiencies in health

care delivery.59 Waste avoidance gets more to the point of resource allocation, where attempts

are made to avoid using resources that do not add value.

Rationing has been justified for reasons of limited resources in the U.S. healthcare system

at the level of health care delivery. It has been argued that specific criteria should be used to

facilitate a rationing process in the United States.

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The Rationing Process

Health care rationing has been strongly debated and contested in the United States. This

includes approaches to explicit rationing through deterrence, deflection, distraction, dilution,

delay, or denial of services.60 Explicit rationing has been attempted based on varying criteria

with no consensus. For example, it has been argued that age could be used to explicitly ration

health care in the United States. The major concern with this type of rationing is that older

patients may be discriminated against and all of the patient’s clinically significant characteristics

may not be considered.61 Although the explicit and rigid criteria of patient age may not be

justified, it may make sense to incorporate functional abilities into resource allocation decisions

when demand for nursing care for complex, older patients exceeds supply of nursing resources.62

The distinction here, however, must be made for the ethical resource allocation process through

the systematic prioritization of limited resources available to a health care delivery organization.

Organizations understand the nuances of limited resources at their disposal and the needs of the

patient populations. For example, the differences across specialties may require specialty-based

allocation strategies to be used.63 The process for how this allocation is developed and

implemented will be the difference in whether the result is ethically sound or not.

Attempts at rationing are often made to address costs to the health care system but are

often short-sighted. Allocation of resources should not only address whom the system can afford

to treat now, but whom the system cannot afford to treat considering long term costs for short

term gains.64 When patient are excluded from resource allocation based on short-term gains, the

entire system suffers both in terms of patient care and health care costs.

The rationing processes that have received the most negative backlash have been attempts

to explicitly ration health care resources. Explicit rationing occurs when specific and clear

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parameters are set to allocate treatments or services while implicit rationing occurs without a

formalized structure and is susceptible to personal biases.65 Implicit rationing is relatively hidden

compared to explicit rationing, so it tends to receive less publicity and backlash than explicit

rationing.

On the other hand, implicit rationing can slip under the radar and may not even be

conscious decisions by those who are implicitly allocating the limited resources. Although it may

not receive as much attention, implicit rationing may create more problems than explicit

rationing since no systematic attempt at ethical justification has been made for the decision. In

addition, staff and providers can face moral distress when left to implicitly ration at the bedside.

Nurses can face role conflict, feelings of guilt, and distress when they are face moral challenges

of prioritizing at the bedside.66 Physicians can also face these and other challenges when left to

implicitly ration. Physicians may implicitly or subconsciously ration by proxy when they are

deterred from patient care by paperwork burden and excessive prior authorization

requirements.67 This results in rationing of care, yet rationing that is not transparent or available

for public scrutiny.

Both implicit and explicit rationing may incorporate varying situational factors. This may

include potential length of life and quality of life, or broad well-being and happiness in addition

to life years.68 These may be part of an ethical justification for some forms of resource allocation

processes; However, when used as either uniform criteria for all patients or when decided by

opinion on an unstructured case-by-case basis, affronts to patient justice may occur. If explicit

rationing criteria is too rigid, for example, patients who have unique needs can be overlooked. If

left to opinion-based implicit rationing by individuals, however, individual bias can be

introduced to the decision-making process, contributing to unjust health disparities. This

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demonstrates how both explicit and implicit rationing are problematic and lack ethical

justification.

Systematic allocation of resources is important, but health care rationing – either explicit

or implicit – is seriously morally flawed. In addition, the term “rationing” is politically and

emotionally charged, making productive discussions about resource allocation in terms of

“rationing” difficult to impossible. Attempts to address allocation of resources should move

away from the language of rationing to create more productive debate. However, linguistic

changes in the naming of rationing are not justified when they are superficial and only serve to

hide social visibility, avoid painful social conversations and avert ethical scrutiny.69 Discussing

resource allocation at the point of health care delivery must have meaningful differences from

existing debate on health care rationing. There is a need for an ethically justified approach to

health care resource allocation.

5bii Ethical Resource Allocation

While health care rationing based on uniform criteria of patient characteristics is unethical, it is

possible to carry out ethical resource allocation. Ethical resource allocation is based on a

foundation of goals and tolerable costs to the patient and should be organized through a

framework for organizational policy.

Goals and Tolerable Costs  

Ethical resource allocation should be founded in patient goals and tolerable costs. Goals

and tolerable costs should be the starting point for making decisions in health care’s resource-

limited settings. This includes but is not limited to cases of medical futility.

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A patient’s goals can be identified and defined in terms of the treatment process through

shared decision-making and the informed consent process. While the informed consent process is

useful, it still faces many challenges, including unknown or disputed risks for serious harm, and

determining when this type of controversial risk is serious enough to disclose.70 These challenges

should be addressed through shared decision-making facilitated by the mutual trust developed

through shared decision-making. When determining goals and tolerable costs of individual

patients, the informed consent process combined with shared decision-making can identify

whether the patient’s goals are aligned with treatment benefits and risks, even those which may

be uncertain. The shared decision-making process allows for the provider to determine which

benefits and risks may be most relevant to share with the patient based on their goals. This is an

essential component of identifying goals and tolerable costs, especially when assessing medical

treatments that may be new or innovative. While medical innovation is generally considered to

be positive for patient care, it can complicate informed consent and medical decision-making.

For example, surgical innovation such as new devices, technology, procedures, or applications

may have the potential to be either beneficial, ineffective, but foregoing new innovations could

also harm the patient by foregoing possible benefits of the novel treatment.71 Sharing new

innovations as potential treatment options should depend on the patient’s expressed goals, as

well as the patient’s values, especially values related to the patient’s weight of risks and benefits.

Providers must have the communication skills to help patients navigate the assessment of

benefits and risks of treatment. Patients have varying backgrounds, perspectives and values that

may influence decision-making so providers must understand and include these individual

patient characteristics in patient communication. Importantly, the hope for survival or need for

concrete action could create cognitive disorientation during decision-making, so providers need

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to navigate between hope and realism.72 Providers must be realistic in estimation of potential

treatment benefit and frame benefits versus risk in a way that patients can understand and assess

compared to their values and goals. When discussing treatment options, providers should also

consider existential dimensions of patient communication such as evasive maneuvers, the

presence of powerful emotions, and attempts to avoid conversations about dying or functional

decline before death.73 Patients may be coping with their disease and the difficult medical

decision-making process through counterproductive, possibly non-conscious responses.

Providers should recognize and address these potential barriers to effective communication with

patients. For example, when prescribing or deprescribing medications, a physician should

consider the patient’s individual therapeutic goals, benefits and risks, the needs of the patients

related to cure versus minimizing functional impairment, patient age and frailty, and the adverse

effects or potential for significant harm from a medication.74 Different patients have differing

needs and benefits versus risks may be weighed differently based on the patient’s goals and

values. Health care delivery organizations can facilitate this decision-making through policy and

an ethical resource allocation framework to support shared decision-making between physicians

and patients.

In addition, ethical resource allocation will include a multidisciplinary approach to

meeting patient’s goals of care. For example, hospice may be the best option to meet the goals of

care for some patients. Hospice services are multidisciplinary and incorporate physicians, nurses,

clergy, social workers, volunteer caretakers, family members, and payers that provide monetary

and business incentives for hospice referrals.75 The multidisciplinary approach to hospice and

other patient-centered approaches to care means that the health care delivery organization plays a

crucial role in coordinating and incentivizing team-based approaches to patient care.

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Organizational policy should also support goals of care discussions through support of

patient-centered care. These goals of care discussions can include both short term outcomes -

such as mortality and morbidity, and long-term outcomes - such as disability, worsening quality

of life, and loss of functional capacity.76 Discussing goals of care with patients will help to

determine what is important them and to prioritize interventions that are aligned with their values

and preferences. Goals of care discussions can follow a four-step patient-centered process that

includes establishing a diagnosis, discussing prognosis, defining goals of care and making

decisions about treatment.77 This will help patients to understand the severity of their illness and

then align their values with the options available for treatment.

Goals of care discussions should be documented for clarity and accountability. Routine

goals of care documentation can help to promote better communication, partnership and clinical

decision-making with patients.78 Documentation of goals of care discussions can create better

interdisciplinary communication, and create accountability for physicians to incorporate a

patient’s goals of care into care planning. Importantly, improved documentation of goals of care,

such as advance care planning for patients with terminal cancer, can improve quality of care.79

Documentation of goals of care incorporates the patient’s values and preferences into the official

care planning process and ensures that the outcomes that are important the patient are prioritized.

Goals of care discussions are essential for effective patient-centered care, but can create

some challenges to providers of care as well as overall policy development for the organization

and health care system. Potential challenges or special considerations for goals of care

discussions include cultural differences, patients who lack decision-making capacity, and the role

of medical technology.80 These challenges do not stop at the level of the physician-provider

interaction. Goals of care interventions create challenges at the individual, organizational and

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systems levels.81 The provider faces challenges with the patient interaction, and the organization

and systems levels face challenges in providing the necessary support for these discussions and

documentation to take place. Goals of care discussions require adequate team structures, training

and resources for initiating conversations.82 Health care delivery organizations and health care

delivery systems must provide this support for goals of care to be effectively incorporated into

patient care plans. This is a worthwhile approach because goals of care communication can

improve end of life quality for patients, including palliative care plans.83 When patients are

facing difficult clinical decisions, especially during the end of life, goals of care discussions and

documentations can clarify the best course of action for the patient according to their values and

preferences.

Patient goals begin the process of ethical resource allocation, then tolerable costs must be

incorporated to balance decision-making that is in the patient’s best interests. Health care

organizations can help providers to assess tolerable costs by facilitating effective risk assessment

of patients using both personal risk and comparative risk to show patients big picture of their

personal risk and help with interpretation of options and decision making.84 When facilitating

autonomous patient decision-making, tolerable risks and costs to the patient are equally as

important as the probability of meeting a patient’s defined goals. When the costs outweigh the

benefits to the patient, it will not make sense to provide that treatment to the patient. This is the

natural beginning to ethical resource allocation. Ethical resource allocation should first and

foremost begin with aligning beneficial treatments with patient goals and tolerable risks.

Tensions between administrators and physicians can occur when cost-saving measures

appear to conflict with physician autonomy. This can be addressed by increasing physician

leadership and creating a collaborative atmosphere between administrators and providers of

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care.85 Including physicians on the leadership team help to alleviate communication barriers and

tensions with the clinical providers and staff within the organization.

Tolerable cost assessments should include financial outcomes, quality of life factors,

social justice and organizational ethics.86 This means that the tolerable cost assessment of

providing a treatment should not only consider the individual patient’s tolerable financial costs

and quality of life factors of treatment, but also social justice and organizational ethics. The

assessment should ask not only “is this financially tolerable?” and “will the patient have a better

quality of life?” but also, “will this decision be supported by social justice?” and “will this

decision fulfill the organization’s ethical obligations, based on its moral agency?”

Health care organizational policy that prioritizes assessment of patient goals as well as tolerable

costs (at both the patient and organizational level) is aligned with the human right to quality

health care. The human rights framework is not only based on respect for autonomy, but also the

value of individual dignity, integrity, and vulnerability.87 The needs of patients as well as the

tolerable costs of decisions should be assessed using a gauge of human dignity, integrity of

persons, and respect for human vulnerability. Once the focus on patient goals and tolerable costs

has been established, a framework to facilitate justified allocation of resources can be developed.

Until now, there has been inconsistency in definitions of equity and ethical concepts related to

allocation and priority setting for health care resources.88 An effective framework for resource

allocation should establish relevant ethical concepts and apply principles of health are equity.

Developing a Framework for Resource allocation

A framework for resource allocation is needed for health care delivery organizations to

manage available, limited resources. Until now, discourse related to resource allocation in health

care has primarily been focused on national and global management of limited health care

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resources. Specifically, global health discourse is moving toward a focus on state universal

health coverage, including discussions surrounding which services should be included, who

should be served, who should be served first, how coverage could be based on need, how the

greatest improvement of health could be facilitated, how to require coverage based on ability to

pay versus need, and how health care spending will fit into overall national spending.89 While a

global approach is noble, it may be far from consensus. At the national level, resource allocation

has also varied and been based on differing priorities and values. For example, in the UK, the

National Institute for Health Care Excellence serves as a designated organization to provide

ethical justification for resource allocation that privileges cost effectiveness, but also considers

other social and ethical values.90 While some countries have established national health care

priority setting, the United States is far from establishing an overarching national policy for

health care resource allocation. Even when (and if) a national or global approach is established;

health care delivery organizations will still need to make decisions on how to allocate resources

available to them since each health care delivery organization in the united states will always

face unique challenges based on geographic location and patient mix.

There are many barriers to connecting frameworks for healthcare priority setting and

practical policy-making.91 Health care delivery organizations each face unique challenges to

implementing ethical resource allocation policy and procedures. A resource allocation

framework must be designed to fit the needs of diverse delivery organizations and patient

populations. Within a single health care delivery organization, there is a range of decision-

makers, settings, scope and type of decisions, and criteria for resource allocation.92 An ethical

framework for resource allocation should incorporate this organizational diversity while also

creating a structured process that can be followed uniformly. This will require a focus on the

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process and structure of decision-making that is flexible to fit to different organizational

structures in health care delivery.

So far, the most developed published theory that begins to address this need is Norman

Daniels’ accountability for reasonableness theory of healthcare resource allocation. Daniels’

theory establishes a process rather than requiring agreement on principles, incorporating

elements of decision-making and moral legitimacy through the following key elements:

transparency for the foundations of decisions, rational appeals that everyone can accept as

relevant to meeting needs fairly, and procedures revising decisions if there are challenges.93 It

attempts to address the gap between national health care planning and local realities within

limited resources by applying priority-setting criteria to health systems.94 The accountability for

reasonableness theory is an approach that incorporates some useful elements for resource

allocation. This theory addresses legitimacy and fairness of care access based on publicly

accessible rationales that are assessed to be relevant for meeting the patient’s needs under

resource constraints.95 Some components of accountability for reasonableness are especially

useful for an ethical resource allocation framework. For example, the publicity condition is

important for critical care unit bed allocations as direct communication between physicians and

end-users can improve fairness of decisions.96 While this theory has useful elements, it is

incomplete in its approach to ethical decision-making within the health care delivery

organization.

Accountability for reasonableness seeks both legitimacy and fairness while considering

morally relevant needs and can be a valuable tool for setting limits in health care; however, it

still needs to be specified to achieve fair, explicit, limit-setting decisions within health care

organizations for treatment decisions about needs versus preferences, and is open to serious

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disagreement about ethical legitimacy of choices.97 Accountability for reasonableness does not

incorporate the distributive justice concerns related to social determinants of health and its

process does not incorporate the importance of patient values and goals in ethical decision-

making. Assumptions are made on behalf of the patient, which may or may not be accurate. The

multicultural and diverse nature of the U.S. population requires that an ethical resource

allocation framework incorporate the diverse needs of patients that respects the nature of human

vulnerability, acknowledges the social responsibility of health care organizations and is

ultimately in support of the human right to health care. The accountability for reasonableness

theory, on the other hand, includes utilitarian-like cost-effectiveness calculations, disregarding

separateness of persons, which could be unfair to individual interests sacrificed for group.98 A

framework for ethical resource allocation should incorporate elements of cultural competency

and shared decision-making to adequately address the key factors of individual patient values,

preferences, and goals.

The resource allocation framework should give health care delivery organizations the

structure and process for basing resource allocation decisions on justice with the goal of

promoting human rights. Resource allocation decisions may include both efficiency and equity

principles with potential decision-making criteria including health gain, clinical effectiveness,

and the ability to provide quality of life improvements.99 These decisions will be facilitated at the

organizational policy level, and at the beside. Ethics committees will play a key role in

facilitating these decisions at both levels. Ethics committees will be involved in developing

organizational policy and also consulting at the bedside. Clinical ethics consultation should

prioritize the conversation and mediation of the decision-making process and look for closure

where parties feel a deep sense of completeness in the outcome, rather than a specific

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endpoint.100 The resource allocation framework will emphasize the process of matching patient

goals with treatments that have the best chance of meeting those goals.

The role of the provider is also essential in this process. When delivering care in a

resource poor environment (where clinicians and health care delivery organizations have

knowledge but not means to carry out beneficial interventions,) ethical decision-making at both

the organizational and provider level can be improved through experience, adaptability, cultural

sensitivity, situational awareness, beneficence, courage, honesty and fairness.101 The framework

must not only include provisions for transparency and appeals, but also focus on the

organizational culture plus leadership and provider competencies that will facilitate ethical

decision-making. The role of nursing is also important since ethical conflicts related to

healthcare provider and system-level factors can directly affect a nurse’s capacity to address

complex clinical situations at the bedside, including skill and confidence in the organization’s

culture of ethics.102 The role of providers and staff should be emphasize in a resource allocation

framework within health care delivery organizations. Health care delivery organizations poses a

unique role in the facilitation of ethical organizational culture and point of care decision-making.

The resource allocation framework should also include transparency of the decision-

making process. This decision-making process should always have the patient-physician

relationship as the point of focus. A transparent discussion is needed to determine how

comparative effectiveness research can be balanced between physician discretion, patient

autonomy and system-level restrictions, with a goal of using clinical data to inform decision-

making within a flexible system responsive to the complexity of health care.103 Decisions about

resource allocation at the level of health care delivery should incorporate clinical data and best

practices with the flexibility to meet patient-specific values and goals. Cost should also be part of

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this discussion where relevant since there is a need for clear, explicit, transparent, inclusive

process to determine how costs should be controlled, based on a shared social understanding.104

A resource allocation framework will incorporate other related concepts, such as accountability

for reasonableness and evidence-based medicine, although existing concepts are not

comprehensive and must be supplemented with additional framework elements. For example,

evidence-based medicine seeks to generalize treatments, which may not be appropriate for all

individuals in an ethnoculturally diverse context such as in the United States.105 In general, an

ethical resource allocation framework should encompass a structure in which health care delivery

organizations can make decisions when facing finite resources, supported by human rights,

organizational moral agency, patient care quality, and justice.

1 Gabbay, E., J. Calvo‐Broce, K. B. Meyer, T. A. Trikalinos, J. Cohen, and D. M. Kent. "The Empirical Basis for Determinations of Medical Futility." J Gen Intern Med 25, no. 10 (Oct 2010): 1083‐9. 

2 Saric, L., I. Prkic, and M. Jukic. "Futile Treatment‐a Review." [In eng]. J Bioeth Inq 14, no. 3 (Sep 2017): 329‐37. 3 Olmstead, J. A., and M. D. Dahnke. "The Need for an Effective Process to Resolve Conflicts over Medical Futility: A Case Study and Analysis." Crit Care Nurse 36, no. 6 (Dec 2016): 13‐23. 

4 Neville, T. H., A. Ziman, and N. S. Wenger. "Blood Products Provided to Patients Receiving Futile Critical Care." J Hosp Med 12, no. 9 (Sep 2017): 739‐42. 

5 Misak, C. J., D. B. White, and R. D. Truog. "Medically Inappropriate or Futile Treatment: Deliberation and Justification." J Med Philos 41, no. 1 (Feb 2016): 90‐114. 

6 Yew Kong, Lee, Low Wah Yun, and Chirk Jenn Ng. "Exploring Patient Values in Medical Decision Making: A Qualitative Study." PLoS One 8, no. 11 (Nov 2013). 

7 Margenthaler, Julie A. M. D. Facs, and David W. M. D. Facs Ollila. "Breast Conservation Therapy Versus Mastectomy: Shared Decision‐Making Strategies and Overcoming Decisional Conflicts in Your Patients." Annals of Surgical Oncology 23, no. 10 (Oct 2016): 3133‐37. 

8 Chen, Jie, Daniel C. Mullins, Priscilla Novak, and Stephen B. Thomas. "Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities." Health Education & Behavior 43, no. 1 (February 2016): 25‐34. 

9 Jiang, Z., L. Yang, P. Guo, and S. Gong. "Autonomy and Authority in Medical Futility." J Biomed Res 28, no. 6 (Nov 2014): 433‐4. 

10 Mohindra, R. K. "Medical Futility: A Conceptual Model." J Med Ethics 33, no. 2 (Feb 2007): 71‐5. 11 Epstein, Wendy Netter. "Nudging Patient Decision‐Making." Washington Law Review 92, no. 3 (2017): 1255‐315. 12 Shin, Dong Wook, Juhee Cho, Debra L. Roter, So Young Kim, Hyung Kook Yang, Keeho Park, Hyung Jin Kim, et al. "Attitudes toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists." Psycho ‐ Oncology 26, no. 6 (Jun 2017): 770‐78. 

13 White, D. B., N. Ernecoff, P. Buddadhumaruk, S. Hong, L. Weissfeld, J. R. Curtis, J. M. Luce, and B. Lo. "Prevalence of and Factors Related to Discordance About Prognosis between Physicians and Surrogate Decision Makers of Critically Ill Patients." Jama 315, no. 19 (May 17 2016): 2086‐94. 

                                                            

Page 244: An Ethical Framework for Organizational Resource

 

236

                                                                                                                                                                                                14 Geros‐Willfond, K. N., S. S. Ivy, K. Montz, S. E. Bohan, and A. M. Torke. "Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults." J Relig Health 55, no. 3 (Jun 2016): 765‐77. 

15 Ernecoff, N. C., F. A. Curlin, P. Buddadhumaruk, and D. B. White. "Health Care Professionals' Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals‐of‐Care Discussions." JAMA Intern Med 175, no. 10 (Oct 2015): 1662‐9. 

16 Cauley, C. E., S. D. Block, L. A. Koritsanszky, J. D. Gass, J. L. Frydman, S. M. Nurudeen, R. E. Bernacki, and Z. Cooper. "Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study." J Palliat Med 19, no. 5 (May 2016): 529‐37. 

17 Schneiderman, L. J. "Defining Medical Futility and Improving Medical Care." J Bioeth Inq 8, no. 2 (Jun 2011): 123‐31. 

18 Neville, T. H., J. F. Wiley, E. S. Holmboe, C. H. Tseng, P. Vespa, E. C. Kleerup, and N. S. Wenger. "Differences between Attendings' and Fellows' Perceptions of Futile Treatment in the Intensive Care Unit at One Academic Health Center: Implications for Training." Acad Med 90, no. 3 (Mar 2015): 324‐30. 

19 Dzeng, E., A. Colaianni, M. Roland, D. Levine, M. P. Kelly, S. Barclay, and T. J. Smith. "Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study." J Gen Intern Med 31, no. 1 (Jan 2016): 93‐9. 

20 Teunis, Teun M. D., Stein M. D. Janssen, Thierry G. M. D. PhD Guitton, David M. D. PhD Ring, and Robert M. D. Parisien. "Do Orthopaedic Surgeons Acknowledge Uncertainty?" Clinical Orthopaedics and Related Research 474, no. 6 (Jun 2016): 1360‐69. 

21 Jiang, Z., L. Yang, P. Guo, and S. Gong. "Medical Futility in the Era of Evidence‐Based Medicine." J Biomed Res 28, no. 4 (Jul 2014): 249‐50. 

22 McQuoid‐Mason, D. J. "Should Doctors Provide Futile Medical Treatment If Patients or Their Proxies Are Prepared to Pay for It?" S Afr Med J 107, no. 2 (Jan 30 2017): 108‐09. 

23 Barnard, David. "Vulnerability and Trustworthiness." Cambridge Quarterly of Healthcare Ethics 25, no. 2 (Apr 2016): 288‐300. 

24 Leppin, Aaron L., Marleen Kunneman, Julie Hathaway, Cara Fernandez, Victor M. Montori, and Jon C. Tilburt. "Getting on the Same Page: Communication, Patient Involvement and Shared Understanding of "Decisions" in Oncology." Health Expectations 21, no. 1 (Feb 2018): 110‐17. 

25 Bandini, Julia I., Andrew Courtwright, Angelika A. Zollfrank, Ellen M. Robinson, and Wendy Cadge. "The Role of Religious Beliefs in Ethics Committee Consultations for Conflict over Life‐Sustaining Treatment." Journal of Medical Ethics 43, no. 6 (Jun 2017): 353. 

26 Wilkinson, D. J. C. "Rationing Conscience." Journal of Medical Ethics: The Journal of the Institute of Medical Ethics 43, no. 4 (2018‐01‐13 2017): 226‐29. 

27 Reed, Peter, Douglas A. Conrad, Susan E. Hernandez, Carolyn Watts, and Miriam Marcus‐Smith. "Innovation in Patient‐Centered Care: Lessons from a Qualitative Study of Innovative Health Care Organizations in Washington State." BMC Family Practice 13 (2012): 120. 

28 Dreachslin, Janice L. "Diversity Management and Cultural Competence: Research, Practice, and the Business Case." Journal of Healthcare Management 52, no. 2 (Mar/Apr 2007): 79‐86. 

29 Simon, J. R., C. Kraus, M. Rosenberg, D. H. Wang, E. P. Clayborne, and A. R. Derse. ""Futile Care"‐an Emergency Medicine Approach: Ethical and Legal Considerations." Ann Emerg Med 70, no. 5 (Nov 2017): 707‐13. 

30 Huynh, T. N., E. C. Kleerup, P. P. Raj, and N. S. Wenger. "The Opportunity Cost of Futile Treatment in the Icu*." Crit Care Med 42, no. 9 (Sep 2014): 1977‐82. 

31 Tubbs, James B., Jr. A Handbook of Bioethics Terms.  Washington, UNITED STATES: Georgetown University Press, 2009. 

32 Ter Meulen, Ruud. "Solidarity and Justice in Health Care: A Critical Analysis of Their Relationship." Diametros: An Online Journal of Philosophy 43 (2018‐01‐13 2015): 1‐20. 

33 Ter Meulen, R. "Solidarity, Justice, and Recognition of the Other." Theor Med Bioeth 37, no. 6 (Dec 2016): 517‐29. 

34 Edgar, Andrew, and Stephen Pattison. "Flourishing in Health Care." Health Care Analysis : HCA 24, no. 2 (Jun 2016): 161‐73. 

35 Kinnear, John, and Ruth Jackson. "Constructing Diagnostic Likelihood: Clinical Decisions Using Subjective Versus Statistical Probability." Postgraduate Medical Journal 93, no. 1101 (Jul 2017): 425. 

Page 245: An Ethical Framework for Organizational Resource

 

237

                                                                                                                                                                                                36 FitzGerald, Chloe, and Samia Hurst. "Implicit Bias in Healthcare Professionals: A Systematic Review." BMC Medical Ethics 18 (2017). 

37 Bailey, Zinzi D., Nancy Krieger, Madina Agénor, Jasmine Graves, Natalia Linos, and Mary T. Bassett. "Structural Racism and Health Inequities in the USA: Evidence and Interventions." The Lancet 389, no. 10077 (2017): 1453‐63. 

38 Wallace, M., J. Crear‐Perry, L. Richardson, M. Tarver, and K. Theall. "Separate and Unequal: Structural Racism and Infant Mortality in the Us." Health Place 45 (May 2017): 140‐44. 

39 Sargent‐Cox, K. "Ageism: We Are Our Own Worst Enemy." Int Psychogeriatr 29, no. 1 (Jan 2017): 1‐8. 40 Pritchard‐Jones, L. "Ageism and Autonomy in Health Care: Explorations through a Relational Lens." [In eng]. Health Care Anal 25, no. 1 (Mar 2017): 72‐89. 

41 Marcum, James A. "Clinical Decision‐Making, Gender Bias, Virtue Epistemology, and Quality Healthcare." Topoi: An International Review of Philosophy 36, no. 3 (2017‐12‐19 2017): 501‐08. 

42 Phibbs, Sandi Cleveland, Jennifer Faith, and Sheryl Thorburn. "Patient‐Centred Communication and Provider Avoidance: Does Body Mass Index Modify the Relationship?" The Health Education Journal 76, no. 1 (Feb 2017): 120‐27. 

43 Lewis, J. A., M. G. Williams, E. J. Peppers, and C. A. Gadson. "Applying Intersectionality to Explore the Relations between Gendered Racism and Health among Black Women." J Couns Psychol 64, no. 5 (Oct 2017): 475‐86. 

44 Mattarozzi, Katia PhD, Valentina PhD Colonnello, Francesco M. S. N. De Gioia, and Alexander PhD Todorov. "I Care, Even after the First Impression: Facial Appearance‐Based Evaluations in Healthcare Context." Social Science & Medicine 182 (Jun 2017): 68. 

45 Alam, Rahul, Sudeh Cheraghi‐Sohi, Maria Panagioti, Aneez Esmail, Stephen Campbell, and Efharis Panagopoulou. "Managing Diagnostic Uncertainty in Primary Care: A Systematic Critical Review." BMC Family Practice 18 (2017). 

46 Lyell, David, Farah Magrabi, Magdalena Z. Raban, L. G. Pont, Melissa T. Baysari, Richard O. Day, and Enrico Coiera. "Automation Bias in Electronic Prescribing." BMC Medical Informatics and Decision Making 17 (2017). 

47 Tapper, E. B. "Consults for Conflict: The History of Ethics Consultation." Proc (Bayl Univ Med Cent) 26, no. 4 (Oct 2013): 417‐22. 

48 Arnason, Gardar. "The Role and Obligations of Ethicists as Members of Ethics Committees in Professional Organizations." AJOB Neuroscience 8, no. 1 (Jan‐Mar 2017): 18‐20. 

49 Romain, Frederic, and Andrew Courtwright. "Can I Trust Them to Do Everything? The Role of Distrust in Ethics Committee Consultations for Conflict over Life‐Sustaining Treatment among Afro‐Caribbean Patients." Journal of Medical Ethics: The Journal of the Institute of Medical Ethics 42, no. 9 (2018‐01‐13 2016): 582‐85. 

50 Altisent, Rogelio, Nieves Martín‐Espildora, and Maria Teresa Delgado‐Marroquín. "Health Care Ethics Consultation: Individual Consultant or Committee Model? Pros and Cons." American Journal of Bioethics 13, no. 2 (2018‐01‐13 2013): 25‐27. 

51 Marcus, Brian S., Gary Shank, Jestin N. Carlson, and Arvind Venkat. "Qualitative Analysis of Healthcare Professionals' Viewpoints on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas." HEC Forum 27, no. 1 (March 2015): 11‐34. 

52 Jansky, Maximiliane, Gabriella Marx, Friedemann Nauck, and Bernd Alt‐Epping. "Physicians' and Nurses' Expectations and Objections toward a Clinical Ethics Committee." Nursing Ethics 20, no. 7 (Nov 2013): 771‐83. 

53 Hamric, A. B., and E. G. Epstein. "A Health System-Wide Moral Distress Consultation Service: Development and Evaluation." [In eng]. HEC Forum 29, no. 2 (Jun 2017): 127-43. 54 Weisleder, P. "Health Care Rationing in a Just Society: The Clinical Effectiveness Model." [In eng]. Semin Pediatr Neurol 22, no. 3 (Sep 2015): 201‐4. 

55 Davies, Ben. "Fair Innings and Time‐Relative Claims." Bioethics 30, no. 6 (2018‐01‐13 2016): 462‐68. 56 Oczkowski, S. "Antimicrobial Stewardship Programmes: Bedside Rationing by Another Name?" J Med Ethics 43, no. 10 (Oct 2017): 684‐87. 

57 Malaiyandi, D. P., G. V. Henderson, and M. A. Rubin. "Transfusion of Blood Products in the Neurocritical Care Unit: An Exploration of Rationing and Futility." Neurocrit Care  (Dec 29 2017). 

58 Kulkarni, K., S. J. Karssiens, H. Massie, and H. Pandit. "Smoking and Orthopaedic Surgery: Does the Evidence Support Rationing of Care?" Musculoskeletal Care 15, no. 4 (Dec 2017): 400‐04. 

59 Strech, D., and M. Danis. "How Can Bedside Rationing Be Justified Despite Coexisting Inefficiency? The Need for 'Benchmarks of Efficiency'." J Med Ethics 40, no. 2 (Feb 2014): 89‐93. 

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                                                                                                                                                                                                60 Owen‐Smith, A., J. Donovan, and J. Coast. "How Clinical Rationing Works in Practice: A Case Study of Morbid Obesity Surgery." Soc Sci Med 147 (Dec 2015): 288‐95. 

61 Reese, P. P., A. L. Caplan, R. D. Bloom, P. L. Abt, and J. H. Karlawish. "How Should We Use Age to Ration Health Care? Lessons from the Case of Kidney Transplantation." J Am Geriatr Soc 58, no. 10 (Oct 2010): 1980‐6. 

62 Bail, K., and L. Grealish. "'Failure to Maintain': A Theoretical Proposition for a New Quality Indicator of Nurse Care Rationing for Complex Older People in Hospital." Int J Nurs Stud 63 (Nov 2016): 146‐61. 

63 Higgs, M., R. Fernandez, S. Polis, and V. Manning. "Similarities and Differences in Nurse‐Reported Care Rationing between Critical Care, Surgical, and Medical Specialties." J Patient Saf  (Nov 2 2016). 

64 Martin, L. J., M. H. Roper, L. Grandjean, R. H. Gilman, J. Coronel, L. Caviedes, J. S. Friedland, and D. A. Moore. "Rationing Tests for Drug‐Resistant Tuberculosis ‐ Who Are We Prepared to Miss?" BMC Med 14 (Mar 23 2016): 30. 

65 Oei, Grace. "Explicit Versus Implicit Rationing: Let's Be Honest." [In English]. American Journal of Bioethics 16, no. 7 (2018‐01‐13 2016): 68‐70. 

66 Vryonides, Stavros, Evridiki Papastavrou, Andreas Charalambous, Panayiota Andreou, and Anastasios Merkouris. "The Ethical Dimension of Nursing Care Rationing." [In English]. Nursing Ethics 22, no. 8 (Dec 2015): 881‐900. 

67 Sheeler, R. D., T. Mundell, S. A. Hurst, S. D. Goold, B. Thorsteinsdottir, J. C. Tilburt, and M. Danis. "Self‐Reported Rationing Behavior among Us Physicians: A National Survey." J Gen Intern Med 31, no. 12 (Dec 2016): 1444‐51. 

68 van de Wetering, E. J., N. J. van Exel, and W. B. Brouwer. "Health or Happiness? A Note on Trading Off Health and Happiness in Rationing Decisions." Value Health 19, no. 5 (Jul‐Aug 2016): 552‐7. 

69 Fleck, Leonard M. "Choosing Wisely." Cambridge Quarterly of Healthcare Ethics 25, no. 3 (Jul 2016 2017‐10‐06 2016): 366‐76. 70 Kocarnik, Jonathan M. "Disclosing Controversial Risk in Informed Consent: How Serious Is Serious?" American Journal of Bioethics 14, no. 4 (2014): 13‐14. 

71 Meyerson, Denise. "Innovative Surgery and the Precautionary Principle." Journal of Medicine and Philosophy 38, no. 6 (2013): 605‐24. 

72 Joffe, Steven, and Jennifer W. Mack. "Deliberation and the Life Cycle of Informed Consent." Hastings Center Report 44, no. 1 (2018‐01‐13 2014): 33‐35. 

73 Schulz, Valerie Marie M. D. Frcpc M. P. H., Allison M. BHSc M. D. Ccfp Crombeen, Denise BSc M. D. Ccfp Fcfp Marshall, Joshua M. D. Mcisc Ccfp Shadd, Kori A. PhD LaDonna, and Lorelei PhD Lingard. "Beyond Simple Planning: Existential Dimensions of Conversations with Patients at Risk of Dying from Heart Failure." Journal of Pain and Symptom Management 54, no. 5 (Nov 2017): 637. 

74 Hilmer, Sarah N., Danijela Gnjidic, and David G. Le Couteur. "Thinking through the Medication List: Appropriate Prescribing and Deprescribing in Robust and Frail Older Patients." Australian Family Physician 41, no. 12 (Dec 2012): 924‐8. 

75 Halabi, Sam. "Selling Hospice." The Journal of Law, Medicine & Ethics 42, no. 4 (December 2014): 442‐54. 76 Pratesi, A., F. Orso, C. Ghiara, A. Lo Forte, A. C. Baroncini, M. L. Di Meo, E. Carassi, and S. Baldasseroni. "Cardiac Surgery in the Elderly: What Goals of Care?" Monaldi Arch Chest Dis 87, no. 2 (Jul 18 2017): 852. 77 Sedhom, R., and D. Barile. "Discussing Goals of Care with Families Using the Four Steps." Gerontol Geriatr Med 2 (Jan-Dec 2016): 2333721416664446. 78 Yarnell, C., and R. Fowler. "The Case for Routine Goals-of-Care Documentation." BMJ Qual Saf 25, no. 9 (Sep 2016): 647-8. 79 Harle, I., S. Karim, W. Raskin, W. M. Hopman, and C. M. Booth. "Toward Improved Goals-of-Care Documentation in Advanced Cancer: Report on the Development of a Quality Improvement Initiative." Curr Oncol 24, no. 6 (Dec 2017): 383-89. 80 Dunlay, S. M., and J. J. Strand. "How to Discuss Goals of Care with Patients." Trends Cardiovasc Med 26, no. 1 (Jan 2016): 36-43. 81 Cummings, A., S. Lund, N. Campling, C. R. May, A. Richardson, and M. Myall. "Implementing Communication and Decision-Making Interventions Directed at Goals of Care: A Theory-Led Scoping Review." BMJ Open 7, no. 10 (Oct 6 2017): e017056. 82 Wittenberg, E., B. Ferrell, J. Goldsmith, H. Buller, and T. Neiman. "Nurse Communication About Goals of Care." J Adv Pract Oncol 7, no. 2 (Mar 2016): 146-54. 

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                                                                                                                                                                                                83 Hanson, L. C., S. Zimmerman, M. K. Song, F. C. Lin, C. Rosemond, T. S. Carey, and S. L. Mitchell. "Effect of the Goals of Care Intervention for Advanced Dementia: A Randomized Clinical Trial." JAMA Intern Med 177, no. 1 (Jan 1 2017): 24-31. 84 Schwartz, Peter H. "Comparative Risk: Good or Bad Heuristic?" American Journal of Bioethics 16, no. 5 (2016): 20‐22. 

85 Castlen, J. P., D. J. Cote, W. A. Moojen, P. A. Robe, N. Balak, J. Brennum, M. Ammirati, T. Mathiesen, and M. L. D. Broekman. "The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice." World Neurosurg 102 (Jun 2017): 420-24. 86 Blanchard, Jeremy R. M. D. M. M. M. C. P. E. Facp Fccp. "Applying the Risk Discernment Process." Physician Leadership Journal 2, no. 1 (Jan/Feb 2015): 36‐39. 

87 Brännmark, Johan. "Respect for Persons in Bioethics: Towards a Human Rights‐Based Account." Human Rights Review 18, no. 2 (Jun 2017): 171‐87. 

 88 Lane, Haylee, Mitchell Sarkies, Jennifer Martin, and Terry Haines. "Equity in Healthcare Resource Allocation Decision Making: A Systematic Review." Social Science & Medicine 175 (Feb 2017): 11. 

89 Rumbold, B., R. Baker, O. Ferraz, S. Hawkes, C. Krubiner, P. Littlejohns, O. F. Norheim, et al. "Universal Health Coverage, Priority Setting, and the Human Right to Health." Lancet 390, no. 10095 (Aug 12 2017): 712‐14. 

90 Rumbold, B., A. Weale, A. Rid, J. Wilson, and P. Littlejohns. "Public Reasoning and Health‐Care Priority Setting: The Case of Nice." Kennedy Inst Ethics J 27, no. 1 (2017): 107‐34. 

91 Kapiriri, L., and D. Razavi. "How Have Systematic Priority Setting Approaches Influenced Policy Making? A Synthesis of the Current Literature." Health Policy 121, no. 9 (Sep 2017): 937‐46. 

92 Harris, C., K. Allen, C. Waller, and V. Brooke. "Sustainability in Health Care by Allocating Resources Effectively (Share) 3: Examining How Resource Allocation Decisions Are Made, Implemented and Evaluated in a Local Healthcare Setting." BMC Health Serv Res 17, no. 1 (May 9 2017): 340. 

93 Daniels, N. "Accountability for Reasonableness." [In eng]. Bmj 321, no. 7272 (Nov 25 2000): 1300‐1. 94 Byskov, J., B. Marchal, S. Maluka, J. M. Zulu, S. A. Bukachi, A. K. Hurtig, A. Blystad, et al. "The Accountability for Reasonableness Approach to Guide Priority Setting in Health Systems within Limited Resources‐‐Findings from Action Research at District Level in Kenya, Tanzania, and Zambia." Health Res Policy Syst 12 (Aug 20 2014): 49. 

95 Daniels, N. "Decisions About Access to Health Care and Accountability for Reasonableness." J Urban Health 76, no. 2 (Jun 1999): 176‐91. 

96 Cooper, A. B., A. S. Joglekar, J. Gibson, A. H. Swota, and D. K. Martin. "Communication of Bed Allocation Decisions in a Critical Care Unit and Accountability for Reasonableness." BMC Health Serv Res 5 (Oct 31 2005): 67. 

97 Nunes, R., and G. Rego. "Priority Setting in Health Care: A Complementary Approach." Health Care Anal 22, no. 3 (Sep 2014): 292‐303. 

98 Badano, G. "If You're a Rawlsian, How Come You're So Close to Utilitarianism and Intuitionism? A Critique of Daniels's Accountability for Reasonableness." Health Care Anal  (Mar 22 2017). 

99 Ratcliffe, J., E. Lancsar, R. Walker, and Y. Gu. "Understanding What Matters: An Exploratory Study to Investigate the Views of the General Public for Priority Setting Criteria in Health Care." Health Policy 121, no. 6 (Jun 2017): 653‐62. 

100 Fiester, Autumn. "Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure." The American Journal of Bioethics 15, no. 1 (2015): 29‐36. 

101 Iserson, Kenneth V. "Providing Ethical Healthcare in Resource‐Poor Environments." HEC Forum  (January 19 2018). 

102 Pavlish, Carol PhD R. N. Faan, Katherine M. A. R. N. Brown‐Saltzman, Loretta M. S. N. R. N. Cgrn So, Amy M. S. N. R. N. C. N. L. Heers, and Nicole M. S. N. R. N. Iorillo. "Avenues of Action in Ethically Complex Situations: A Critical Incident Study." Journal of Nursing Administration 45, no. 6 (Jun 2015): 311. 

103 Peppercorn, Jeffrey, S. Yousuf Zafar, Kevin Houck, Peter Ubel, and Neal J. Meropol. "Does Comparative Effectiveness Research Promote Rationing of Cancer Care?" Lancet Oncology 15, no. 3 (Mar 2014): e132‐8. 

104 Fleck, Leonard M. "Choosing Wisely." Cambridge Quarterly of Healthcare Ethics 25, no. 3 (Jul 2016): 366‐76. 105 Whitley, Rob PhD, Cecile M. D. Rousseau, Elizabeth PhD Carpenter‐Song, and Laurence J. M. D. Frcpc Kirmayer. "Evidence‐Based Medicine: Opportunities and Challenges in a Diverse Society." Canadian Journal of Psychiatry 56, no. 9 (Sep 2011): 514‐22. 

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Chapter 6: Organizational Policy Framework for Resource Allocation  

Ethical health care resource allocation will promote and protect health care quality and human

rights. This can be accomplished through organizational policy that includes fairness in value

assessments and response to challenges of nonbeneficial interventions. It can be implemented

through a practical, formalized, and cohesive resource allocation framework for health care

delivery organizations that includes decision-making process, methods, and evaluation

mechanisms.

6a Resource allocation

Resource allocation should focus on patient-directed goals, using cultural competence and shared

decision-making as tools to alleviate inequalities caused by social determinants of health.

Focusing on assessment of patient goals and tolerable first and foremost will ensure that

treatments are aimed at the patient’s values and goals of care. When all desired patient goals can

be met, a mechanism must be in place to evaluate and implement prioritization of scarce

resources. This will involve assessment of both fairness and value. The prioritization of scarce

resources can be illustrated through applications to the medical futility and end-of-life care

debate.

6 ai Assessing Fairness & Value

Fairness and value will be the basis for resource allocation assessments. Fairness is

explained in terms of equity and justice, and value is explained in terms of quality and cost.

Fairness (Equity & Justice)

The resource allocation framework will be based in fairness and equity on two major

levels – the bedside level and the organizational policy level and the. The bedside level will

address fairness of the physician-patient interaction including treatment plans made through

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shared decision-making while the organizational policy level will address equity and justice for

the population or community of patients that the health care delivery organization serves.

Support for bedside decision-making in the face of scarce resources includes concerns of

justice from the perspective of both the patient and the health care provider. Justice must be

protected at the bedside to protect the patient from provider bias. Many times, physicians do not

even realize that they are making biased decision at the bedside, and it can be a challenge to

bring these biases to light. There is a tendency to underestimate one’s own susceptibility to

cognitive bias, also called intellectual deference, where individuals often fail to listen to advice

on avoiding bias due to their overconfidence about their own intellectual abilities.1 Physicians

may not realize or think that they are susceptible to bias, and may be engaging in implicit bias

when making bedside rationing decisions. This can create a range of emotional responses from

both the provider and patient level, depending on the perceived fairness of both process and

outcome. Anger and frustration can occur when an unfavorable outcome results from an unfair

procedure, while guilt and anxiety can occur when an unfair process results in a favorable

outcome.2 The fairness of both process and outcome are essential for the well-being of both

patient and provider. Lack of fairness in process or outcome may lead to moral distress in

providers and staff. There is a significant negative correlation between perceived organizational

justice and moral distress of nurses, illustrating the need for organizations to create appropriate

policies that are transparent and clear.3 When policies demonstrate procedural and distributive

justice, nurses and physicians will be less likely to face moral distress when facing difficult

bedside allocation decisions.

The fairness of process can be influenced by factors of personal motivation. Individuals

can be motivated toward justice based on rational utility maximization, status and social value

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maximization, or personal identity associated with moral priorities.4 Since there is potential for

variation of motivations between patients and providers, a standardized, structured, ethically

sound approach to this type of decision-making should be established. This will support unbiased

decision-making and also support shared decision-making between the provider and patient.

The provider and patient must also consider goals of care outcomes when determining

which decision is founded in equity and justice. Using economic opportunity restoration as the

sole justification for care is not enough to explain justice in health care. Palliative care illustrates

this point. Palliative care is offered when opportunities cannot be restored and is instead focused

on less painful treatment and treatments for those who cannot be cured.5 If the outcome is not

aligned with the patient’s goals, preferences, and needs it will not be based in justice and equity.

Both the process and outcome must be based in equity and justice for ethical resource allocation

to be established.

The social nature of health care helps to explain the importance of fairness in the process

and outcomes of health care delivery. Freedom is situated or socially bound meaning that society

has a role in creating the alternatives available for people to choose. In other words, individuals

do not exist in isolation and there is a shared responsibility for bad health even if a health

outcome seems to be the product of free choice.6 The social responsibility that results from the

social nature of health care, combined with the moral agency of health care delivery

organizations, places moral obligations on the health care delivery organization to provide

equitable health care. Importantly, those with social disadvantage lack material, social, and/or

environmental equality such as: the inability to purchase goods, services, influence; treatment

within society based on social factors such as race; and exposure to concentrated poverty.7 These

factors offer a limited amount of control over a person’s social situation, so they have limited

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moral relevance to health care justice and equity. The life-course perspective explains that

economic and social factors influence opportunities across lifetimes and generations.8 Even if an

individual pursues opportunity to improve their social situation, social disadvantages from

previous experiences, as well as social disadvantages from generations before them can continue

to negatively impact their opportunity for health and well-being. This again provides a limited

amount of control over social context to the individual. Generational trajectories of health

disparities can even be influenced by non-health policies – for example, the historical impact of

exclusionary federal government housing policies which continue to affect the housing market

today.9 When an individual starts life with severe socially-constructed challenges and barriers to

health, health is compromised by generational and historical from the day a person is born. These

disadvantages are not morally relevant reasons for a person to receive inadequate health care.

Justice related to the outcomes of how health care resources are allocated is called

distributive justice. Distributive justice can be based on: the contribution principle, or allocation

of resources based on a person’s sum of contributions to others; the equality principle, or

allocation of resources as the same for all persons involved; or the need principle of social

justice, which allocates resources based on individual needs and desires.10 Since there are several

ways that distributive justice can be calculated and analyzed, it must be clear how an

organizational framework will approach distributive justice analysis. The goal of distributive

justice is to avoid morally arbitrary discrimination and address social conditions that interfere

with one’s ability to develop and exercise their potential capabilities.11 In health care, those

morally arbitrary social conditions that pose barriers to health opportunity should be eliminated

or corrected to ensure just allocation of resources.

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In addition, power differentials can create health inequities that must be met by political

support for inclusion and human rights to health.12 This political support is an essential

component of justice and human rights in health care. Health care delivery organizations have a

role in addressing this power differential as well. Although political climate of power will have a

significant effect on a person’s ability to achieve the right to health, this right will ultimately be

carried out by the health care delivery organization. The right to health elicits a right to socially

controllable causes of health under budget constraints, as well as a moral duty of those in the

position to influence these social causes for the right holder.13 The health care delivery

organization has a moral duty to influence and address social causes that influence access to the

right to health, within budget constraints.

The social value established by power dynamics can influence the realization of the right

to health care. Social value is determined not just by outcomes, but also by process that

individuals are exposed to.14 This explains the importance of both procedural and distributive

justice. There may also be a role for interactional justice in addition to procedural justice, which

may function differently in terms of fair process versus equity of social comparison.15 In

summary, fairness includes process, outcomes and treatment of individuals that is based only on

morally relevant criteria.

Equity and justice principles are essential foundations for the resource allocation

framework since they will ensure that only morally relevant criteria are used to determine

processes and outcomes for fair health care distribution. In addition to the essential piece of

equity and justice, the resource allocation framework will incorporate value.

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Value (Cost versus Benefit)

Value can be evaluated through robust comparative effectiveness and evidence-based

assessment. Assessment of value at the level of the delivery organization will ensure that

priorities are set within the limited resources available to the population that the organization

serves. The heterogeneous and fragmented health system in the United States cause difficulty in

equitable resource allocation at the levels of national policy and health care financing.16 This

results in health care delivery organizations receiving varying levels of resources compared to

the needs of the communities that they serve. Some health care delivery organizations have more

resources per patient than others. Those who have the fewest resources to serve their patient

population will especially need to consider value to ensure that community needs are being met

to the best of the organization’s ability, enacting their role in the human right to health.

Value assessments first need to determine the patient’s individual goals of care. There is

a need for an established process that incorporates patient values into decision-making and

practice guidelines in health care.17 Without a full understanding of the patient’s goals,

preferences, and needs there is no way to determine whether the treatment is beneficial for the

patient or not since health care is value-laden and effectiveness of a treatment depends on the

patient’s goals.

For example, cancer treatment is value-laden. Cancer treatment is not just the biology of

cancer, but also patient preferences, so treatments should be personalized and determined

through shared decision-making.18 The approach to value analysis must incorporate all effective

alternatives. For example, prevention, access to early diagnosis and radiotherapy are key factors

to effective cancer treatment, even though funding tends to be concentrated on cancer treatment

drugs.19 Different approaches may be more beneficial or less beneficial for different patients,

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depending on their goals of care, preferences, and values. Share decision-making is an essential

tool for defining the goals of a patient’s care and developing a treatment plan based on those

goals.

The cost of care should be considered by health care delivery organizations when

developing resource allocation policy, but should only be one component of the analysis. A

middle-ground needs to be found between the benefit principle, or resources toward the

maximization and cost-effectiveness, and the worse off principle, which is related to equity.20

Those who need the care the most, based on criteria that includes goals of care may have some

level of weight against others who have less need or where a treatment is not aligned with their

goals of care. Purely focusing on cost-effectiveness may violate social values of equity and

distributive justice.21 While addressing cost-effectiveness of care, the value equation adds in the

essential piece of patient needs and goals. In other words, cost-effectiveness alone is not enough

to determine the ethical allocation of health care resources. Patient characteristics, needs and

goals must also have some weight and be incorporated into the decision-making process. In

addition, when incentivizing patients to engage in their health care, their personal needs and

reasonable options must be clear to them. Health incentives require rational deliberation and

must avoid restriction of options through coercive paternalism.22 The patient’s role in the

resource allocation framework will be essential, since patient characteristics are crucial variables

in the value equation.

Patient needs, preferences and values should be an integrated component of the resource

allocation framework. Frameworks should incorporate a range of patient-relevant outcomes, or

the flexibility to create tailored treatment where patient input assigns values to the range of

outcomes.23 There is no way to create a one-size-fits all approach that will address the needs and

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goals of all patients, and the framework must incorporate this variable factor. Patient-centered

care and shared decision-making are tools that can be incorporated into the framework to ensure

that patient variables are adequately incorporated into value assessments. Different options may

offer the highest value for different patients since there are a range of treatments that may or may

not be aligned with a patient’s goals and preferences.24 The treatment that one patient values may

be different than that of another patient with the same clinical condition because of the nature of

human beings and personal values.

On an organizational policy level, values can be categorized and weighted, but there

should still be room for individual patient values to be incorporated into decision-making

through shared decision-making and patient-centered care. Health care delivery organizations are

may weigh and consider relevant value criteria for the community and population that they serve.

This value criteria could include disease severity, potential for health, past health loss,

socioeconomic status, area of living, gender, race, ethnicity, religion, sexual orientation,

economic productivity, care for others, and catastrophic health expenditures.25 These factors may

or may not be morally relevant for the health care population and resource constraints of the

delivery organizations.

The mix of patient vulnerability that a health care delivery organization serves may also

need to be incorporated into the assessment of value. Incapacitated and alone adults are

particularly vulnerable, and there is a need for adequately funded and monitored solutions that

incorporate a multidisciplinary, collaborative approach to protect their rights.26 This highlights

the need for and emphasis that should be placed on collaboration among care teams to provide

the highest value care that is consistent with patient goals.

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In addition to individual patient goals, the organization should consider long-term

organizational goals in resource allocation decisions. Short-term costs, long-term cost savings

and patient outcomes should all be considered in organizational value analysis, with the ultimate

goal of determining the value added by an intervention, then developing evidence-based

guidelines supporting high-value choices.27 While a decision may save money in the short-term,

a solution that will be costly in the long-term may not carry the highest value. Those who lead

and develop policies for health care delivery organizations can use evidence-based guidelines to

determine which decisions might be most cost-effective in both the short and long-term.

Difficult decisions related to value and justice are common in health care delivery

organizations in the United States, and especially common when facing debates over medical

futility and end-of-life care decision-making.

6aii Medical Futility and End-Of-Life Care

Medical futility cases are often brought up at the end of life when interventions are

prolonging life but not achieving many or any other goals of care. These cases bring up difficult

questions of both justice and value. Medical interventions with little or no benefit to the patient

may also be costly and may even be inequitable when they are not aligned with the patient’s

goals of care. These issues of non-beneficial care often arise at the end of life when a patient

receives treatment that will not achieve any of their goals of care and only prolong their dying

process.

Medical Intervention with Little or no Benefit Addressing medical futility related to the resource allocation framework because cases of

medical futility are those that offer least benefit and some of the highest human and financial

costs. There can be conflict in medical futility cases due to underlying, unrevealed beliefs and

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values that are not being addressed in the case. The resource allocation model, facilitated by

health care providers, staff, and ethics consultants, can help to unearth some of these underlying

issues to address the true reasons for conflict.

Based on the variable resources available to delivery organizations in the United States,

the health care resource allocation framework will provide a process that allows for decision-

making within the context of organizational constraints. This process should include

establishment of local clinical practice guidelines, methods for documentation and monitoring,

review and measurement of data, process to provide feedback, education and facilitation of

shared decision-making and the development of an environment that encourages blame-free

discussion of waste.28 These approaches can be applied at all health care delivery organizations,

but the process specifics may differ depending on organizational constrains and needs.

The varying constraints of health care delivery organizations in the United States means

that there must be flexibility to make decisions within the constraints of available resources.

Because of this, a framework to resolve conflicts of nonbeneficial treatment should be process-

driven.29 The process for making decisions about non-beneficial care should be consistent, but

there is some room for organization-specific outcome goals that addresses organization-specific

resource constraints. The resource allocation framework will have major consistencies among

institutions, however. The framework should be consistent in fair and explicit policy to support

consensus, respect and understanding when providers face conflict resolution related to

perceived nonbeneficial treatment.30 Although providers should be given autonomy of clinical

decision-making, they should be given institutional support and guidance on decisions related to

nonbeneficial treatment.

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Physicians may face challenges to shared decision-making when patients demand a

specific treatment that is not consistent with their goals of care. The physician’s role is not to

give the patient whatever treatment they demand, but to facilitate coherent deliberation to

support the patient’s autonomy, offering reasoned judgements for what is beneficial and

appropriate.31 Organizational policy can support physicians in communicating this reasoned

judgement and providing an environment where they are empowered to make decisions that are

most closely aligned with the patient’s goals of care. The process of communication about

nonbeneficial care is a critical piece for decision-making related to nonbeneficial care. Proactive

communication among all stakeholders is needed to prevent and resolve issues related to

nonbeneficial treatment.32 This includes the physician, the patient or surrogate, the patient’s

family, and other stakeholders when relevant.

Physicians need organizational support for shared decision-making, especially when

facing diverse patient populations. Physicians need culturally effective strategies for end of life

discussions when they face barriers to discussing end of life issues with patients, especially when

communicating with patients of different ethnicity.33 Organizations can provide support for

cultural competency and communication tools so that providers can effectively and confidently

discuss relevant treatment options with patients. This will also help providers to communicate

treatment options in terms of a patient’s values, preferences and goals.

For example, providers may need support in communicating about nonbeneficial CPR.

Nonbeneficial CPR occur for many reasons including misrepresentation of CPR efficacy,

misunderstanding of prognosis, lack of empathetic and skilled communication, difficulty of

patient and family acceptance, cultural rejection of death and dying, and difficulty with meaning-

making and connection.34 In addition, there is also a bias toward action in medicine, which could

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be a cause of the overvaluing of CPR.35 Effective shared decision-making would alleviate these

problems and prevent non-beneficial CPR. The efficacy of this intervention should be adequately

explained along with empathetic and skilled communication of prognosis. In addition,

communication to address potential cultural biases and issues of family acceptance could help to

reduce the incidence of non-beneficial CPR. Avoiding non-beneficial CPR can prevent both

patient suffering and unnecessary burden on resources to the health care system.

Another example of policy in practice to address non-beneficial care is in the context of

the ICU. When considering admission, discharge and triage for the ICU, patients real wishes

should be determined through proper advance care planning that includes a discussion of realistic

probability of cure, benefit of intervention, and dying despite the intervention, plus options of

hospice.36 Advanced care planning can ensure that patients are getting treatment that is consistent

with their goals of care, even if they get too sick to communicate these goals later. This is not

only good for patients, but also good for providers. Collaboration and workload are predictors of

burnout from ICU staff and providers who perceive nonbeneficial treatment in the ICU.37 When

patients are receiving care that is not perceived as beneficial, nurses and providers can feel an

emphasized strain and moral distress, adding to workload burden and burnout.

In addition to advanced care planning for patients, addressing nonbeneficial treatments

that are already in motion is also part of the decision-making process for equitable, value-based

resource allocation. When a treatment is causing burden and not providing significant benefit to

the patient, it could be determined as nonbeneficial care. It is ethically permissible to stop

technological impediments to death when the burdens to the patient outweigh the benefits.38

When a patient is receiving extraordinary interventions that are keeping them alive but not

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benefiting them based on goals of care, it is ethically permissible to discontinue the

nonbeneficial treatment.

There is a need for organizational policy to prevent unnecessary patient suffering caused

by nonbeneficial care, such as incorporation of ethics committee consultation to support

physicians when facing conflicts related to nonbeneficial treatment.39 Organizational policies

will set the culture and priorities based on the resources that they have to address the needs of

their patients. Ethics committees should be part of the framework structure since they can

address specific ethical dilemmas at the bedside, as well as facilitate robust ethical delibration at

the organizational policy level. In addition, organizations should consider the resources available

to them and the options that they may provide to patients that will benefit them the most based

on their goals of care. For example, organizational leadership should establish strong connections

with palliative care services and organizational processes for beneficial palliative care transfers.40

Even if an extraordinary measure is not appropriate or beneficial to the patient anymore, it will

always be appropriate to directly care for the patient’s pain and suffering. Palliative care plays an

important role in caring for patients when more aggressive treatments are not appropriate for

their goals and preferences.

Organizations can also provide support for providers and staff through education and

training. Organizations provide support and training for patient-provider communication to

promote conversations about nonbeneficial care before a crisis arises, with the goal of reducing

communication barriers such as time constraints, inadequate provider communication skills and

training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and

limitations in advance care planning.41 There are many reasons why a provider may have

difficulty communicating with their patient and engaging in effective shared decision-making.

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Health care delivery organizations play a critical role in supporting providers to give them the

tools and break down barriers to effective patient communication. Hospital policy on

nonbeneficial care can improve end of life care and resolve conflicts in decision-making.42

Policy interventions at the level of the health care delivery organization can give practical

support to health care providers and staff when assessing benefits and value of care for their

patients. This can be especially helpful when providers and staff are caring for patients at the end

of life.

End of Life Care Only patients can define the level of benefit and cost they experience from an

intervention, so their values and goals need to be at the center of this process. Although quality

of life added may be one goal of care, end-of-life care decision-making processes should

examine all benefits of treatment, not just incremental length of life added.

One of the major areas of focus at end of life is adequate and accurate assessment of

palliative care needs. There is wide variation in physician survival prediction accuracy and the

accurate identification of people nearing the end of life that could benefit from palliative care

services.43 Organizational policy and resource allocation framework can address this issue by

providing evidence-based guidance on how to approach assessment for palliative care referrals.

Conversations about transitioning to appropriate end-of-life care should occur for timely

palliative intervention when there is a high cost of care with little or no value to the patient.44

This is not only considering financial costs, but quality of life costs to the patient. The patient

may pay a high price in terms of their quality of life to gain little or no benefit from a treatment.

The physician and patient should share the probabilities of costs versus benefits of a treatment

and then make a decision based on the value weights that the patient places on both the costs and

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benefits. This type of shared decision-making takes skilled communication practice from

physicians and staff caring for the patient. Physicians and nurses need effective communication

skills to help clarify expectations and end of life care wishes.45 The physician is the expert on

treatment options while the patient is the expert on their values and goals.

The physician should understand the goals of the patient to make appropriate

recommendations to their patient. The process of advance care planning and discussion of goals

of care should incorporate patient-centered, shared decision-making principles incorporating the

patient’s personal values and life goals.46 When these discussions happen early on in the care,

share decision-making is more effective and patients can effectively communicate their goals and

values related to end of life care. For example, when cancer patients have appropriate

information about the option for a do not resuscitate (DNR) order at the end of life, their care

quality can be improved.47 Patients need to have a meaningful conversation with their providers

about the true risks and possible benefits of an intervention, and providers need to listen carefully

to the patient’s wishes and goals of care. Health care organizational policy can help to support

this type of communication between the physician and provider by supporting shared decision-

making education and other resources needed for effective communication. This is especially

crucial at the end of life and is often needed in the intensive care unit (ICU.) Due to the

variability in end-of-life ICU care, there is a need for need for clinical, educational and policy

interventions to encourage the use of informed goals of care.48 Standardized, evidence-based

approaches to end of life decision-making in the ICU can be incorporated into the resource

allocation framework. In addition, evidence-based guidance on other types of beneficial care for

patients can help to improve outcomes and reduce costs. Timely enrollment in hospice care, for

example, can reduce health care expenditures at the end of life.49 When hospice would benefit

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the patient the most, they should be referred to hospice rather than continuing to receive care that

is not meeting their goals.

Providers face many barriers to end-of-life decision-making. For example, cultural issues

can bring up a conflict between individualism and stereotyping since cultural and religious can

be complex and negotiated by context, political, social and existential situation.50 Providers and

staff should receive support and training on how to navigate between cultural and religious

differences of patients. Due to the significant impact that a patient’s culture and religion have on

preferences and goals of care, a provider needs to understand these patient characteristics for

effective shared decision-making. Importantly, a patient’s culture can impact preferences for end

of life treatment so the institutional policy should promote an understanding individual needs of

each patient before documenting advance care planning.51 Incorporating potential cultural and

religious preferences into advance care planning protocols can create effective support for

culturally competent, patient-centered shared decision-making. Spirituality can play a significant

role at the end of life for patients, family members and clinicians, since end of life care can bring

up questions about meaning, purpose, relationships, and destiny as well as the need to meet

spiritual goals of peace, comfort, love, and reconnection.52 Incorporating an understanding of

religion and spirituality into advance care planning can enhance the patient’s experience and

likelihood of achieving goals of care. Physicians should ensure that care is aligned with diverse

patient goals at the end of life by eliciting the patient's explanatory model of illness, addressing

the patient’s religious or spiritual values, determining the patient’s desired approach to truth

telling, understanding how the patient's family is involved in care, and negotiating cultural

conflicts when they arise.53 When a provider actively seeks to understand the patient’s

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background and values – including culture and religious beliefs – shared decision-making will be

improved and care can be aligned with the patient’s goals of care.

An understanding of the patient’s culture and spiritual beliefs can also help the physician

to understand important aspects of the patient’s decision-making process. For example, end of

life care that is consistent with the patient’s goals and desires is not always consistent with the

conventional notion of autonomy when patients do not want to make explicit decisions about

their end of life care.54 In this case, the health care provider may need a background in cultural

competence to understand how the patient prefers to make decisions and gain a comfort with

shared decision-making in this context. In addition, some patient’s may prefer nondisclosure due

to cultural or spiritual beliefs. Physicians in the United States need cultural self-awareness and

knowledge of other cultures when patients prefer nondisclosure. Otherwise, they may face

conflict due to the professional value of truth telling.55 Organizational policy can help to support

the provider and alleviate any internal ethical dilemmas when there is conflict between personal

beliefs and patient preferences. When the health care organization has clear policy on how to

address these types of situations, and has support for physicians who face moral distress, the

decision-making process can be improved for both the provider and the patient.

Organizational policy should also promote collaboration among disciplines and

specialties within the organization. An interdisciplinary approach to communicating about end of

life care planning should be used to improve advance care planning and increase effective and

timely palliative and hospice care referrals.56 The coordination of health care delivery and

transitions of care will improve the alignment of patient goals with recommended treatments and

interventions. A multidisciplinary approach will also help physicians to address end of life care

issues in a timely manner by providing support and adequate treatment options for their patient.

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Conversations about advance care planning should be ongoing and begin early on in a patient’s

illness because patients may lose the ability to meaningfully communicate goals as their disease

progresses.57 These ongoing conversations should incorporate relevant disciplines, and a plan for

transitions of care. A well-designed organizational policy will improve efficiency, efficacy and

quality of care for patients at the end of life consistent with both equity and value.

6b Resource Allocation Framework: Process, Methods, Assessment & Evaluation

Health care delivery organizations face difficult decisions of health care resource

allocation including but not limited to non-beneficial treatment and end-of-life care.

Organizations have a limited set of resources provided to them through policy and financing of

healthcare and must then determine how to spread those resources among the community of

patients that they serve. A resource allocation framework is needed for these organizations to

make decisions when facing scarcity of resources based on equity and value assessments. This

resource allocation framework should include process, methods, assessment and evaluation.

6bi Process & Methods The resource allocation framework should be developed at the level of the health care

delivery organization based on moral agency of health delivery organizations and associated

responsibilities toward protection and promotion health and human rights. The process for

resource allocation should incorporate the roles of the physician, patient or surrogate, and ethics

committee.

Process for Resource allocation  

Resource allocation has, thus far, been primarily relegated to national and global debate

on priority setting. National agencies aim to align with the social values of a population into

health care resource allocation by fulfilling procedural justice, accountability and transparency.58

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Although there has been significant policy debate on these issues, comprehensive policy to

address priority setting of health care resources has not been developed yet in the United States.

There have been some themes in public opinion surrounding health care priority setting, but none

have been established as universally accepted. In terms of national health care priority setting,

public opinion tends to favor – in varying weighted distribution – the young over the old, the

severely ill over the less severely ill, and those with self-induced illness or high socioeconomic

status as lower priority, larger health gain but at a diminishing rate, life extension over quality of

life enhancement - although reversed at end of life.59 Differences in public opinion and related

barriers policy have prevented a national framework for health care resource priority setting.

Although efforts toward national policy for health care priority setting is essential,

applied resource allocation at the level of the health care delivery organization is also needed.

There is a need for pragmatic resource allocation that fits within the health care delivery

organizational structure, aligned with political realities, and reflective of unique challenges that

result from the heterogeneity of health care organizations and the patient populations that they

serve.60 Even if and when a national policy framework to set priorities in health care is

developed, health care delivery organizations will still be left to implement these policies within

the unique constraints they face based on their patient population, payer mix and geographic

barriers. Health care delivery is not value neutral and health care leaders should be expected to

carry out national policies while incorporating the moral objectives of the delivery

organization.61 Therefore, an ethical resource allocation framework is needed for health care

delivery organization now and will continue to be needed into the future.

This framework will need to give specific guidance for decision-making processes, but

allow for context-specific decisions based on characteristics of the organization’s patient

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population. For example, an ethical framework for resource allocation should consider the

influence of historical patterns and political pressure, including structures, processes, attitudes,

behaviors and measurable outcomes.62 Due to the high level of population diversity in the united

states, these patterns will vary between different delivery organizations.

An organizational resource allocation framework should incorporate both bedside

decision-making and organizational policy development, as well as a forum where the

community and stakeholders can participate in case review. Once community input has been

gathered, the resource policy committee will engage in a decision-making process that

incorporates analysis, policy development, and education (Appendix B.) The committee will

circle back with the community for commentary before implementing amended or new policy.

This process will follow a cyclical model based on for key process areas: implement, report,

evaluation and assess. (Appendix A.) This model will incorporate the two major levels of the

resource allocation decisions – the organizational policy and bedside decision-making levels.

Resource allocation falls under two major decision-making levels: microallocation decisions,

which are focused on individual persons and macroallocation decisions, such as hospital

budgeting of spending that is available.63 An effective health care delivery resource allocation

framework will need to incorporate both of these levels.

The policy and bedside level of the framework will bet inter-related as bedside decision-

making will inform policy and vice-versa. Education will be a significant connector of these two

levels. The education piece should include didactic approaches to social and health equality,

including the development of empathy and critical self-reflection, that cultivates a lifelong

learning process of culturally sensitive clinical interaction with a recognition of the narrative and

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history of other cultural groups.64 Education within the framework will focus on supporting

shared decision-making and culturally competent patient-centered care.

The organizational policy level will be essential to provide guidance and support for

frontline and bedside decision-making when providers and staff face resource limitations.

Organizational guidance can help with ethical front-line decision-making that avoids

rationalization and denial and instead uses reason combined with empathy.65 This guidance can

help providers to avoid bias in bedside decision-making. Providers will face a lower level of

moral distress and not be forced to rationalize unethical decisions. It will also support effective

shared decision-making and focus on patient goals, preferences and values.

Shared decision-making will be a focus at both the bedside and organizational policy

level of the framework. Shared decision-making is needed to determine the true needs of

patients, and to differentiate between patient needs and desires then comparing benefits and tying

decisions to evidence-based medicine.66 Policy will support providers and staff to engage in

shared decision-making through education and communication tools. Physicians at the bedside

will implement shared decision-making and provide feedback to policy to improve this process

into the future. This feedback loop and connection between the bedside and high-level policy

will be essential for the success of the framework.

The connection between frontline or bedside care and the policy component of the

framework can be supported by incorporating physician leadership in policy decision-making

processes. Physician leadership can help to bridge gaps between clinicians and administrators,

create a unified health care agenda, implement patient-centered improvements, and facilitate

training for clinicians to appreciate the constraints of financial, political and bureaucratic

obligations.67 Involving physician leadership in policy development will ensure that decisions are

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clinically sound and lend credibility to the policy-making piece of the process. It will also assist

with communication between the policy development and implementation of policy at the

bedside. The policy component of the decision-making process will incorporate evidence-based

decision-making shared decision-making processes that provide guidance for physicians at the

bedside. This will include evidence and research to support equity of care. Effectiveness

research can support equity in treatments to those with equal morally relevant needs, and be used

to support education and training.68 Policy that is within the framework but specific to the health

care delivery organization will be responsive to specific resources available to the organization

balanced with the morally relevant needs of the organization’s patient population.

Cultural competence will be an important aspect of policy decision-making and

implementation within the framework. Cultural competence can improve effective

communication and quality of care for patients with diverse sociocultural backgrounds, reducing

racial and ethnic disparities that are both unjust and costly.69 The incorporation of culturally

competent policy development and cultural competence as part of education for providers and

staff will support equitable value-based resource allocation decisions. Cultural competence helps

providers to understand patient goals and preference and to engage in effective communication

with patients. In addition, beneficial tools and approaches can be incorporated into the

framework as they become relevant. For example, technology tools could be considered, such as

the use of telemedicine, if they can improve the efficiency of resource allocation within the

health care delivery organization.70 As new tools such as technology solutions become available,

health care resource allocation policy development can assess and utilize as appropriate.

The connection between organizational policy decisions and bedside decision-making is

essential for an effective resource allocation process at the level of the health care delivery

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organization. Consequences of macro-level decisions should be monitored, and professional

integrity should be protected.71 Incorporating both organizational policy and bedside decision-

making into the resource allocation decision-making process will protect the integrity of both

physicians and patients. The roles of the provider, patient (or surrogate) and ethics committee

will be essential for an effective resource allocation framework process.

Roles of the Provider, Patient and Ethics Committee The provider, patient and ethics committee will all have crucial roles in the resource

allocation framework. The physician-patient interaction should be based on shared decision-

making and mutual respect and aligned with the goal of patient-centered care. The ethics

committee will support and mediate the shared decision-making process when there are

significant barriers or value conflicts between the physician and the patient.

The shared decision-making process is at the foundation of the resource allocation

framework, from both the bedside and policy support perspective. Shared decision-making can

help patients and surrogates more effectively express preferences and understand options more

clearly.72 Shared decision-making also helps physicians. Physicians may engage in shared

decision-making to share uncertainty and avoid interventions or tests with little or no benefit.73

There may be many possible options to treat the patient. Without understanding the patient’s

values and goals, it will be difficult for the physician to advise on which option would be the

most beneficial. It will also help physicians to connect meaning to the treatment that they provide

since it will be clearly aligned with patient benefit. When physicians feel that their work is

meaningful, patient-physician interaction are improved and physician burnout is decreased.74

Both physician and patient satisfaction can then be increased with effective shared decision-

making approaches.

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Share decision-making is facilitated by effective physician communication. Physicians

should elicit patient’s preferences, assess the evidence-based information that patients need, then

arrive at a treatment decision together with the patient, based on the best available evidence

weighted by the patient’s values and preferences.75 The physician is the clinical expert on

treatment options, while the patient is the expert on their own values and goals. The physician

must help the patient to define and express their goals of care, and then match options for

treatment to those expressed goals.

Share decision-making is especially crucial in situations where the solution to meeting a

patient’s goal is not obvious, or where a patient’s goals are impossible to achieve. When facing

ethically contentious decisions, physicians should assess context-specific moral norms then lead

a participatory and inclusive discussion with democratic decision procedures, rather than

focusing solely on the opinion of traditional elites.76 The physician, in other words, must

incorporate the context of the decision-making for the patient in front of them. Medical ethics,

distinct from everyday ethics, incorporates a moral commitment decision-making informed by

professional rather than personal moral judgement – meaning that others should not be asked to

bear the weight of a physician’s personal convictions.77 Physicians must incorporate the patient’s

values and goals, rather than a paternalistic decision based on the physicain’s own personal

values. Organizational policy can support physicians in this process through training and

development of nonclinical competencies. Nonclinical competencies should be included in

physician training and practice-based learning, including communication skills,

professionalism.78 These skills will help the physician to assess the benefit versus the costs to the

patient of a particular treatment option by understanding the patient’s goals and how they can

address situations of conflict. Shared decision-making is not always easy. Obstacles to shared

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decision-making include the inherent uncertainty of most medical decisions, lack of consistency,

and strength and quality of clinical evidence.79 It can be difficult to match a patient’s goals with a

suggested treatment when the outcomes of a treatment are not certain. Health care delivery

organizations can support physicians facing these uncertainties by developing evidence-based,

decision-making guidelines when possible. For example, physician education and palliative care

guidelines can support patient and family-centered end-of-life care.80 Support and guidance from

the resource allocation framework can alleviate some of the moral burden that physicians may

face from decision-making uncertainty.

Frontline staff also play an important role in the development of the resource allocation

framework. Nurses require organizational enact decisions that benefit the patients they care for.

Nursing requires integrity and courage to advocate for patients, intervene during distressing

situations, innovate practices to promote individualized care, question physician orders when

needed, and advocate for safe conditions.81 Creating a culture where nurses are able to engage

with the resource allocation process will benefit patients and contribute to efficient and

efficacious patient care.

In addition, hospital policy should support the surrogate decision-making process

including life-prolonging decisions that require high-intensity care with a high risk of death.82

Surrogates face many barriers and challenges to shared excision-making, especially during

difficult end-of life decisions. Surrogates can face conflict from family dynamics and unspoken

filial expectations, so physicians should facilitate communication to address surrogate coping

and support surrogate decision-making.83 The shared decision-making process can support

surrogates in difficult decision-making, and help to clarify goals of care for the provider.

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When there are conflicts in the shared decision-making process that the provider and

patient or surrogate cannot resolve, clinical ethics committees can provide valuable facilitation

and moderating services. Clinical ethics committees can help with resource allocation decisions

by raising awareness of ethical aspects of resource allocations, bridging clinical practice with

higher-level decisions- and promoting fair resource allocation and stakeholder rights and

interests.84 Clinical ethics committees trained in morally relevant criteria can help to guide

patients and physicians to make decisions together when there are conflicts of value.

The resource allocation framework will need to facilitate a close relationship between

organizational policy and bedside decision-making. In addition, assessment and evaluation that

incorporates a close relationship with the community that the delivery organization serves.

6bii Assessment & Evaluation

The resource allocation framework will include a robust assessment and evaluation

component. This component will facilitate community involvement in both initial needs

assessment and evaluation of established policy for resource allocation.

Assessing Resource Allocation

The assessment process will include defining the patient’s goals, determining the

patient’s tolerable costs (such as quality of life measures or complications,) and ensuring

stakeholder understanding of patient goals and values. When specific policy needs to be

developed based on scarcity of resources, a general assessment will be performed of the benefits

of the intervention and which types of patients would benefit from the intervention. The process

will be transparent with an appeals process. Resource allocation should incorporate evidence-

based care including guideline creation, guideline adherence, assessing quality measures and

guidelines, outcomes research and safety.85 The assessment of resource allocation policy will

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focus on the development of guidelines taking bedside decision-making challenges to the policy

development committee responding to these challenges.

Stakeholder deliberation is an important part of the resource allocation process since

value judgements and preferences may vary between various stakeholders.86 The assessment of

policy priorities will incorporate stakeholders and community members that the health care

delivery organization serves. Prior to the development of policy, the community and stakeholders

will be invited to a designated forum for open resource allocation discussion. Problems that have

been identified at the bedside will be presented and discussed at this forum, and community input

will be documented. Since health care is – at least partially – a publicly financed community

commodity, allocation of resources should incorporate relative social value estimates, social

norms, and citizen values.87 The community forum will be a venue for the community to express

social values and give feedback on allocation decisions that affect them. Values of the

communities that health delivery organizations serve should be incorporated into policy

development, although the weight of community input should be carefully considered88 The

community feedback will be documented for further assessment by the resource allocation

committee. For example, health gains of special interest may be emphasized by the community

but not be aligned with equity of for the population. Health gains may be assessed based on a

reference point where health gains below the reference point are weighted more than health gains

above a reference point.89 If incorporating prioritization for the worse off, it is essential to define

what "worse off" means, such as preferring those with fewer lifetime Quality-Adjusted Life

Years (QALYs.)90 Different types of ethics reviews might be needed for different contexts within

the health delivery organization.91

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The policy committee will deliberate this and other key points, considering community

feedback in their assessment. Public engagement will be important to the framework since it can

help to create legitimacy, transparency and accountability for resource allocation policy by

developing popular support, identifying points of agreement and disagreement, identifying value

judgement and normative aspects of the decision, and garnering public trust in the decision-

making process.92 The community of the health care delivery organization will be invited to

policy discussions in the assessment phase, and also in the policy evaluation phase.

Evaluating Resource Allocation Organizational Policy The framework will be evaluated for effectiveness. After the resource allocation policy

committee has gathered and assessed community feedback, they will develop an ethical resource

allocation policy for the issue discussed. Policy committee assessment will include key ethical

considerations of: distributive justice, procedural justice, interpersonal justice, informational

justice, social responsibility and respect for human vulnerability. The committee will use the

process of accountability for reasonableness when developing the policy and develop associated

education necessary for policy implementation. Once this has occurred, policy will be ready for

stakeholder and community evaluation.

Evaluation methodology should be transparent and incorporate community input. There

is a need for a clear method to evaluate a resource allocation framework, which could

incorporate efficiency and health outcome data that maximizes overall health but also addresses

distribution of benefits and process indicators for allocation.93 This resource allocation criteria

can be mapped out into buckets of feasibility, health level, health distribution, responsiveness,

social and financial risk protection, and improved efficiency.94 Community feedback will be

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assessed within these buckets, and compared to the committees assessment of justice, social

responsibility, and respect for human vulnerability.

Community evaluation will be supported by any relevant data that would help in the

assessment of the policy draft. In the current climate of accountability, data is needed to provide

effectiveness information to consumers and stakeholders.95 Stakeholders should be given all of

the information that they need to effectively evaluate each proposed policy.

Involvement of community members and other stakeholders will not only provide perspectives

that the policy committee may not have considered, but it will also create an environment of trust

between the health delivery organization and the community. Legitimacy of priority setting can

be improved by managing external stakeholder relationships, including government, citizens, the

media and other external interest groups.96 By including the community that the delivery

organization serves in policy evaluation, the priority setting process will be legitimized through

transparency and accountability of the health care delivery organization.

External review is also helpful for the resource allocation committee to establish

outcomes that are important to the key stakeholders, which are the community of patients that the

health care delivery organization serves. Like other program evaluation processes in health care,

the resource allocation committee should be subject to an evaluation process and continuous

process improvement. Program evaluation should include a systematic process to evaluate

established outcomes and determine the possible need for program revision.97 Including

community evaluation in the cycle of resource allocation decisions will provide opportunity for

continuous process improvement. It will also allow the committee to respond to changing

community needs and demands when ethically relevant. In addition, program evaluation in

health care can facilitate individual, team and organizational learning.98 The organization can

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learn what their community needs, giving a voice to those who are directly impacted by resource

allocation decisions.

The community who is most affected by decisions that the health care delivery

organization makes should also be privy to the normative allocation criteria developed by the

committee. The dimensions of equality that are normatively relevant need to be clearly defined

since implicitly unfair allocation will occur without the employment of explicit allocation

criteria.99 When the community is aware of the resource allocation decisions, they can act as

their own advocates to protect against implicit bias in decision-making. Decision-making

processes will be transparent and patients will be empowered with that information, helping them

to become active members in the shared decision-making process.

The community can be given criteria to evaluate resource allocation decisions, and also

the committee process itself. The CDC recommends that a program evaluation framework

includes standards of program utility, feasibility, propriety, and accuracy through a cycle of

describing the program, focusing evaluation design, gathering credible evidence, justifying

conclusions, ensuring and sharing lessons, and engaging stakeholders.100 The committee can

incorporate feedback about specific policy decisions but also about the decision-making process

of the committee itself, as well as the implementation methodology at the bedside.

An ethically sound resource allocation framework is needed for health care organizations

when there are not enough resources to respond to patient demand. This resource allocation

framework must focus on the process that can respond to specific resources available as

compared to the organization’s patient characteristics, payer mix, and other organization-specific

barriers or relevant characteristics. A redefinition of rationing cannot overcome its baggage and

this term can create unnecessary polarization and argument about rationing rather than address

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root of the problem.101 Still, an approach to address limited health care resources is needed.

Although an approach at the national policy level is important, a framework at the level of the

health care delivery organization is also needed. This resource allocation framework will fulfil

the responsibilities that organizations have, based on their moral agency, to protect the right to

health.

1 Ahlstrom‐Vij, Kristoffer. "Procedural Justice and the Problem of Intellectual Deference." Episteme 11, no. 4 (Dec 2014): 423‐42. 

2 Krehbiel, Patricia J., and Russell Cropanzano. "Procedural Justice, Outcome Favorability and Emotion." Social Justice Research 13, no. 4 (December 2000): 339‐60. 

3 Haghighinezhad, G., F. Atashzadeh‐Shoorideh, T. Ashktorab, J. Mohtashami, and M. Barkhordari‐Sharifabad. "Relationship between Perceived Organizational Justice and Moral Distress in Intensive Care Unit Nurses." Nurs Ethics  (Jan 1 2017): 969733017712082. 

4 Hegtvedt, Karen A., and Jody Clay‐Warner. Justice.  Bradford, UNITED KINGDOM: Emerald Group Publishing Limited, 2008. 

5 Knight, Carl, and Andreas Albertsen. "Rawlsian Justice and Palliative Care." Bioethics 29, no. 8 (Oct 2015 2015‐09‐24 2015): 536‐42. 6 Day, Lisa. "Distributive Justice and Personal Responsibility for Choices About Health." [In English]. American Journal of Critical Care 15, no. 1 (Jan 2006): 96‐8. 

7 Braveman, P. "What Are Health Disparities and Health Equity? We Need to Be Clear." Public Health Rep 129 Suppl 2 (Jan‐Feb 2014): 5‐8. 

8 Braveman, P. "What Is Health Equity: And How Does a Life‐Course Approach Take Us Further toward It?" Matern Child Health J 18, no. 2 (Feb 2014): 366‐72. 

9 Woods, L. L., 2nd, M. Shaw‐Ridley, and C. A. Woods. "Can Health Equity Coexist with Housing Inequalities? A Contemporary Issue in Historical Context." Health Promot Pract 15, no. 4 (Jul 2014): 476‐82. 

10 Bierhoff, H.W., R.L. Cohen, and J. Greenberg. Justice in Social Relations. Springer US, 2013. 211‐219 11 Jecker, Nancy S. "Justice." In Bioethics, edited by Bruce Jennings, 1774‐84. Farmington Hills, MI: Macmillan Reference USA, 2014. 

12 Forman, L. "What Do Human Rights Bring to Discussions of Power and Politics in Health Policy and Systems?". Glob Public Health  (Dec 13 2017): 1‐14. 

13 Sreenivasan, G. "Health Care and Human Rights: Against the Split Duty Gambit." Theor Med Bioeth 37, no. 4 (Aug 2016): 343‐64. 

14 Jan, S. "Proceduralism and Its Role in Economic Evaluation and Priority Setting in Health." Soc Sci Med 108 (May 2014): 257‐61. 

15 Collie, Therese, Bradley Graham, and Beverley A. Sparks. "Fair Process Revisited: Differential Effects of Interactional and Procedural Justice in the Presence of Social Comparison Information." Journal of Experimental Social Psychology 38, no. 6 (Nov 2002): 545‐55. 

16 Brock, D. W. "Ethical and Value Issues in Insurance Coverage for Cancer Treatment." Oncologist 15 Suppl 1 (2010): 36‐42. 

17 Zhang, Yuan, Coello Pablo Alonso, Jan Brożek, Wojtek Wiercioch, Itziar Etxeandia‐Ikobaltzeta, Elie A. Akl, Joerg J. Meerpohl, et al. "Using Patient Values and Preferences to Inform the Importance of Health Outcomes in Practice Guideline Development Following the Grade Approach." Health and Quality of Life Outcomes 15 (2017). 

18 Marckmann, G., and J. In der Schmitten. "Financial Toxicity of Cancer Drugs: Possible Remedies from an Ethical Perspective." Breast Care (Basel) 12, no. 2 (May 2017): 81‐85. 

                                                            

Page 279: An Ethical Framework for Organizational Resource

 

271

                                                                                                                                                                                                19 de Groot, F., S. Capri, J. C. Castanier, D. Cunningham, B. Flamion, M. Flume, H. Herholz, et al. "Ethical Hurdles in the Prioritization of Oncology Care." Appl Health Econ Health Policy 15, no. 2 (Apr 2017): 119‐26. 

20 Ottersen, T., O. Maestad, and O. F. Norheim. "Lifetime Qaly Prioritarianism in Priority Setting: Quantification of the Inherent Trade‐Off." Cost Eff Resour Alloc 12, no. 1 (Jan 14 2014): 2. 

21 Rutstein, S. E., J. T. Price, N. E. Rosenberg, S. M. Rennie, A. K. Biddle, and W. C. Miller. "Hidden Costs: The Ethics of Cost‐Effectiveness Analyses for Health Interventions in Resource‐Limited Settings." Glob Public Health 12, no. 10 (Oct 2017): 1269‐81. 

22 Grill, K. "Incentives, Equity and the Able Chooser Problem." J Med Ethics 43, no. 3 (Mar 2017): 157‐61. 23 Addario, Bonnie J., Ana Fadich, Jesme Fox, Linda Krebs, Deborah Maskens, Kathy Oliver, Erin Schwartz, Gilliosa Spurrier‐Bernard, and Timothy Turnham. "Patient Value: Perspectives from the Advocacy Community." Expectations 21, no. 1 (Feb 2018): 57‐63. 

24 Wilkinson, D., and J. Savulescu. "Cost‐Equivalence and Pluralism in Publicly‐Funded Health‐Care Systems." Health Care Anal  (Jan 6 2017). 

25 Norheim, O. F., R. Baltussen, M. Johri, D. Chisholm, E. Nord, D. Brock, P. Carlsson, et al. "Guidance on Priority Setting in Health Care (Gps‐Health): The Inclusion of Equity Criteria Not Captured by Cost‐Effectiveness Analysis." Cost Eff Resour Alloc 12 (2014): 18. 

26 Moye, Jennifer, Casey Catlin, Jennifer Kwak, Erica Wood, and Pamela B. Teaster. "Ethical Concerns and Procedural Pathways for Patients Who Are Incapacitated and Alone: Implications from a Qualitative Study for Advancing Ethical Practice." HEC Forum 29, no. 2 (Jun 2017): 171‐89. 

27 Burnham, J. M., F. Meta, V. Lizzio, E. C. Makhni, and K. J. Bozic. "Technology Assessment and Cost‐Effectiveness in Orthopedics: How to Measure Outcomes and Deliver Value in a Constantly Changing Healthcare Environment." Curr Rev Musculoskelet Med 10, no. 2 (Jun 2017): 233‐39. 

28 Nelson, W. A. "The Ethics of Avoiding Nonbeneficial Healthcare: Unnecessary Treatment Has Both Financial and Moral Implications." Healthc Exec 27, no. 6 (Nov‐Dec 2012): 48, 50‐1. 

29 Olmstead, J. A., and M. D. Dahnke. "The Need for an Effective Process to Resolve Conflicts over Medical Futility: A Case Study and Analysis." Crit Care Nurse 36, no. 6 (Dec 2016): 13‐23. 

30 Nelson, C. M., and B. A. Nazareth. "Nonbeneficial Treatment and Conflict Resolution: Building Consensus." Perm J 17, no. 3 (Summer 2013): 23‐7. 

31 Brett, Allan S. M. D., and Laurence B. PhD McCullough. "Addressing Requests by Patients for Nonbeneficial Interventions." JAMA 307, no. 2 (2012 Jan 11): 149‐50. 

32 Armstrong, Matthew H. M. D. M. A., Joseph K. M. D. J. D. Poku, and Christopher M. M. D. J. D. Burkle. "Medical Futility and Nonbeneficial Interventions: An Algorithm to Aid Clinicians." Mayo Clinic Proceedings 89, no. 12 (Dec 2014): 1599‐607. 

33 Periyakoil, Vyjeyanthi S., Eric Neri, and Helena Kraemer. "No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End‐of‐Life Conversations with Diverse Patients." PLoS One 10, no. 4 (Apr 2015). 

34 Rosenberg, L. B., and D. Doolittle. "Learn and Live?: Understanding the Cultural Focus on Nonbeneficial Cardiopulmonary Resuscitation (Cpr) as a Response to Existential Distress About Death and Dying." Am J Bioeth 17, no. 2 (Feb 2017): 54‐55. 

35 Jecker, N. S. "Doing What We Shouldn't: Medical Futility and Moral Distress." Am J Bioeth 17, no. 2 (Feb 2017): 41‐43. 

36 Nates, J. L., M. Nunnally, R. Kleinpell, S. Blosser, J. Goldner, B. Birriel, C. S. Fowler, et al. "Icu Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research." Crit Care Med 44, no. 8 (Aug 2016): 1553‐602. 

37 Schwarzkopf, D., H. Ruddel, D. O. Thomas‐Ruddel, J. Felfe, B. Poidinger, C. T. Matthaus‐Kramer, C. S. Hartog, and F. Bloos. "Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job among Icu Nurses and Junior and Senior Physicians." Crit Care Med 45, no. 3 (Mar 2017): e265‐e73. 

38 DeMartino, E. S., S. E. Wordingham, J. M. Stulak, B. A. Boilson, K. R. Fuechtmann, N. Singh, D. P. Sulmasy, O. E. Pajaro, and P. S. Mueller. "Ethical Analysis of Withdrawing Total Artificial Heart Support." Mayo Clin Proc 92, no. 5 (May 2017): 719‐25. 

39 Morata, L. "An Evolutionary Concept Analysis of Futility in Health Care." [In eng]. J Adv Nurs  (Jan 19 2018). 40 Jukic, M., L. Saric, I. Prkic, and L. Puljak. "Medical Futility Treatment in Intensive Care Units." [In eng]. Acta Med Acad 45, no. 2 (Nov 2016): 135‐44. 

Page 280: An Ethical Framework for Organizational Resource

 

272

                                                                                                                                                                                                41 Cooper, Z., A. Courtwright, A. Karlage, A. Gawande, and S. Block. "Pitfalls in Communication That Lead to Nonbeneficial Emergency Surgery in Elderly Patients with Serious Illness: Description of the Problem and Elements of a Solution." Ann Surg 260, no. 6 (Dec 2014): 949‐57. 

42 Joseph, R. "Hospital Policy on Medical Futility ‐ Does It Help in Conflict Resolution and Ensuring Good End‐of‐Life Care?" Ann Acad Med Singapore 40, no. 1 (Jan 2011): 19‐25. 

43 White, N., N. Kupeli, V. Vickerstaff, and P. Stone. "How Accurate Is the 'Surprise Question' at Identifying Patients at the End of Life? A Systematic Review and Meta‐Analysis." BMC Med 15, no. 1 (Aug 2 2017): 139. 

44 Margolis, B., L. Chen, M. K. Accordino, G. Clarke Hillyer, J. Y. Hou, A. I. Tergas, W. M. Burke, et al. "Trends in End‐of‐Life Care and Health Care Spending in Women with Uterine Cancer." Am J Obstet Gynecol 217, no. 4 (Oct 2017): 434.e1‐34.e10. 

45 Walczak, A., P. N. Butow, M. H. Tattersall, P. M. Davidson, J. Young, R. M. Epstein, D. S. Costa, and J. M. Clayton. "Encouraging Early Discussion of Life Expectancy and End‐of‐Life Care: A Randomised Controlled Trial of a Nurse‐Led Communication Support Program for Patients and Caregivers." Int J Nurs Stud 67 (Feb 2017): 31‐40. 

46 Myers, J. "Measuring Quality of End‐of‐Life Communication and Decision‐Making: Do We Have This Right?" Cmaj 189, no. 30 (Jul 31 2017): E978‐e79. 

47 Liang, Y. H., C. H. Wei, W. H. Hsu, Y. Y. Shao, Y. C. Lin, P. C. Chou, A. L. Cheng, and K. H. Yeh. "Do‐Not‐Resuscitate Consent Signed by Patients Indicates a More Favorable Quality of End‐of‐Life Care for Patients with Advanced Cancer." Support Care Cancer 25, no. 2 (Feb 2017): 533‐39. 

48 Curtis, J. R., R. A. Engelberg, and J. M. Teno. "Understanding Variability of End‐of‐Life Care in the Icu for the Elderly." Intensive Care Med 43, no. 1 (Jan 2017): 94‐96. 

49 Zuckerman, R. B., S. C. Stearns, and S. H. Sheingold. "Hospice Use, Hospitalization, and Medicare Spending at the End of Life." J Gerontol B Psychol Sci Soc Sci 71, no. 3 (May 2016): 569‐80. 

50 Schweda, M., S. Schicktanz, A. Raz, and A. Silvers. "Beyond Cultural Stereotyping: Views on End‐of‐Life Decision Making among Religious and Secular Persons in the USA, Germany, and Israel." BMC Med Ethics 18, no. 1 (Feb 17 2017): 13. 

51 Ohr, S., S. Jeong, and P. Saul. "Cultural and Religious Beliefs and Values, and Their Impact on Preferences for End‐of‐Life Care among Four Ethnic Groups of Community‐Dwelling Older Persons." J Clin Nurs 26, no. 11‐12 (Jun 2017): 1681‐89. 

52 Swinton, M., M. Giacomini, F. Toledo, T. Rose, T. Hand‐Breckenridge, A. Boyle, A. Woods, et al. "Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit." Am J Respir Crit Care Med 195, no. 2 (Jan 15 2017): 198‐204. 

53 Partain, D. K., C. Ingram, and J. J. Strand. "Providing Appropriate End‐of‐Life Care to Religious and Ethnic Minorities." Mayo Clin Proc 92, no. 1 (Jan 2017): 147‐52. 

54 Romo, R. D., T. A. Allison, A. K. Smith, and M. I. Wallhagen. "Sense of Control in End‐of‐Life Decision‐Making." J Am Geriatr Soc 65, no. 3 (Mar 2017): e70‐e75. 

55 Rising, M. L. "Truth Telling as an Element of Culturally Competent Care at End of Life." J Transcult Nurs 28, no. 1 (Jan 2017): 48‐55. 

56 Nedjat‐Haiem, F. R., I. V. Carrion, K. Gonzalez, K. Ell, B. Thompson, and S. I. Mishra. "Exploring Health Care Providers' Views About Initiating End‐of‐Life Care Communication." Am J Hosp Palliat Care 34, no. 4 (May 2017): 308‐17. 

57 Hutchison, Lauren A., Donna S. Raffin‐Bouchal, Charlotte A. Syme, Patricia D. Biondo, and Jessica E. Simon. "Readiness to Participate in Advance Care Planning: A Qualitative Study of Renal Failure Patients, Families and Healthcare Providers." Chronic Illness 13, no. 3 (Sep 2017): 171‐87. 

58 Landwehr, C., and D. Klinnert. "Value Congruence in Health Care Priority Setting: Social Values, Institutions and Decisions in Three Countries." Health Econ Policy Law 10, no. 2 (Apr 2015): 113‐32. 

59 Gu, Y., E. Lancsar, P. Ghijben, J. R. Butler, and C. Donaldson. "Attributes and Weights in Health Care Priority Setting: A Systematic Review of What Counts and to What Extent." Soc Sci Med 146 (Dec 2015): 41‐52. 

60 Cromwell, I., S. J. Peacock, and C. Mitton. "'Real‐World' Health Care Priority Setting Using Explicit Decision Criteria: A Systematic Review of the Literature." BMC Health Serv Res 15 (Apr 17 2015): 164. 

61 Kekewich, M., J. Landry, and V. Roth. "How Should Health Leaders Approach Morally Contentious Policy Issues?" Healthc Manage Forum 31, no. 1 (Jan 2018): 29‐31. 

Page 281: An Ethical Framework for Organizational Resource

 

273

                                                                                                                                                                                                62 Smith, N., C. Mitton, W. Hall, S. Bryan, C. Donaldson, S. Peacock, J. L. Gibson, and B. Urquhart. "High Performance in Healthcare Priority Setting and Resource Allocation: A Literature‐ and Case Study‐Based Framework in the Canadian Context." Soc Sci Med 162 (Aug 2016): 185‐92. 

63 Kilner, John F. "Healthcare Resources, Allocation Of: I. Macroallocation." In Encyclopedia of Bioethics, edited by Stephen G. Post, 1098‐107. New York: Macmillan Reference USA, 2004. 

64 Wilson‐Mitchell, K., and M. Handa. "Infusing Diversity and Equity into Clinical Teaching: Training the Trainers." J Midwifery Womens Health 61, no. 6 (Nov 2016): 726‐36. 

65 Decety, J., and J. M. Cowell. "Empathy, Justice, and Moral Behavior." AJOB Neurosci 6, no. 3 (2015): 3‐14. 66 Gustavsson, E., and L. Sandman. "Health‐Care Needs and Shared Decision‐Making in Priority‐Setting." Med Health Care Philos 18, no. 1 (Feb 2015): 13‐22. 

67 Zhang, M., J. Volovetz, and M. Teo. "Surgeon Adherence to Medical Ethics as Contingent on Their Leadership in the Changing Economics of Health Care." World Neurosurg 104 (Aug 2017): 979‐80. 

68 Rogers, W., C. Degeling, and C. Townley. "Equity under the Knife: Justice and Evidence in Surgery." Bioethics 28, no. 3 (Mar 2014): 119‐26. 

69 Betancourt, J. R., J. Corbett, and M. R. Bondaryk. "Addressing Disparities and Achieving Equity: Cultural Competence, Ethics, and Health‐Care Transformation." Chest 145, no. 1 (Jan 2014): 143‐48. 

70 Yeow, Adrian, and Kim Huat Goh. "Work Harder or Work Smarter? Information Technology and Resource Allocation in Healthcare Processes." MIS Quarterly 39, no. 4 (Dec 2015): 763. 

71 Nordhaug, M., and P. Nortvedt. "Justice and Proximity: Problems for an Ethics of Care." Health Care Anal 19, no. 1 (Mar 2011): 3‐14. 

72 Wilson, M. E., A. Akhoundi, A. K. Krupa, R. F. Hinds, J. M. Litell, O. Gajic, and K. Kashani. "Development, Validation, and Results of a Survey to Measure Understanding of Cardiopulmonary Resuscitation Choices among Icu Patients and Their Surrogate Decision Makers." BMC Anesthesiol 14 (Mar 8 2014): 15. 

73 Schoenfeld, E. M., S. L. Goff, T. R. Elia, E. R. Khordipour, K. E. Poronsky, K. A. Nault, P. K. Lindenauer, and K. M. Mazor. "The Physician‐as‐Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department." Acad Emerg Med 23, no. 12 (Dec 2016): 1417‐27. 

74 Dobler, C. C., C. P. West, and V. M. Montori. "Can Shared Decision Making Improve Physician Well‐Being and Reduce Burnout?" Cureus 9, no. 8 (Aug 27 2017): e1615. 

75 Tamirisa, N. P., J. S. Goodwin, A. Kandalam, S. K. Linder, S. Weller, S. Turrubiate, C. Silva, and T. S. Riall. "Patient and Physician Views of Shared Decision Making in Cancer." Health Expect 20, no. 6 (Dec 2017): 1248‐53. 

76 Salloch, Sabine. "Same Same but Different: Why We Should Care About the Distinction between Professionalism and Ethics." [In English]. BMC Medical Ethics 17 (2016). 

77 Rhodes, Rosamond. "The Professional Responsibilities of Medicine." In The Blackwell Guide to Medical Ethics, 71‐87: Blackwell Publishing Ltd, 2008. 

78 Sinha, Shashank S., and Michael W. Cullen. "Mentorship, Leadership, and Teamwork." Journal of the American College of Cardiology 66, no. 9 (2015): 1079‐82. 

79 Smith, Quentin W., Richard L. Street, Robert J. Volk, and Michael Fordis. "Differing Levels of Clinical Evidence: Exploring Communication Challenges in Shared Decision Making." Medical Care Research and Review 70, no. 1 suppl (February 2013): 3S‐13S. 

80 Visser, M., L. Deliens, and D. Houttekier. "Physician‐Related Barriers to Communication and Patient‐ and Family‐Centred Decision‐Making Towards the End of Life in Intensive Care: A Systematic Review." Crit Care 18, no. 6 (Nov 18 2014): 604. 

81 Hawkins, Sara F. M. S. N. R. N., and Janice PhD PhD Faan Morse. "The Praxis of Courage as a Foundation for Care." Journal of Nursing Scholarship 46, no. 4 (Jul 2014): 263‐70. 

82 Torke, A. M., G. A. Sachs, P. R. Helft, K. Montz, S. L. Hui, J. E. Slaven, and C. M. Callahan. "Scope and Outcomes of Surrogate Decision Making among Hospitalized Older Adults." JAMA Intern Med 174, no. 3 (Mar 2014): 370‐7. 

83 Su, C. T., R. D. McMahan, B. A. Williams, R. K. Sharma, and R. L. Sudore. "Family Matters: Effects of Birth Order, Culture, and Family Dynamics on Surrogate Decision‐Making." J Am Geriatr Soc 62, no. 1 (Jan 2014): 175‐82. 

84 Magelssen, M., I. Miljeteig, R. Pedersen, and R. Forde. "Roles and Responsibilities of Clinical Ethics Committees in Priority Setting." BMC Med Ethics 18, no. 1 (Dec 1 2017): 68. 

85 Robertson‐Preidler, Joelle, Nikola Biller‐Andorno, and Tricia J. Johnson. "What Is Appropriate Care? An Integrative Review of Emerging Themes in the Literature." BMC Health Services Research 17 (2017). 

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                                                                                                                                                                                                86 Severin, F., W. Hess, J. Schmidtke, A. Muhlbacher, and W. Rogowski. "Value Judgments for Priority Setting Criteria in Genetic Testing: A Discrete Choice Experiment." Health Policy 119, no. 2 (Feb 2015): 164‐73. 

87 Costa‐Font, J., J. R. Forns, and A. Sato. "Participatory Health System Priority Setting: Evidence from a Budget Experiment." Soc Sci Med 146 (Dec 2015): 182‐90. 

88 Wiseman, Virginia L. "Inclusiveness in the Value Base for Health Care Resource Allocation." [In English]. Social Science & Medicine 108 (May 2014): 252‐56. 

89 Wouters, S., N. J. van Exel, K. I. Rohde, and W. B. Brouwer. "Are All Health Gains Equally Important? An Exploration of Acceptable Health as a Reference Point in Health Care Priority Setting." Health Qual Life Outcomes 13 (Jun 10 2015): 79. 

90 Ottersen, T. "Lifetime Qaly Prioritarianism in Priority Setting." J Med Ethics 39, no. 3 (Mar 2013): 175‐80. 91 Flaming, D. "Appropriate Ethics Review Is Required." Healthc Manage Forum 30, no. 1 (Jan 2017): 46‐48. 92 Peacock, S. J. "Public Attitudes and Values in Priority Setting." Isr J Health Policy Res 4 (2015): 29. 93 Angell, B., J. Pares, and G. Mooney. "Implementing Priority Setting Frameworks: Insights from Leading Researchers." Health Policy 120, no. 12 (Dec 2016): 1389‐94. 

94 Tromp, Noor, and Rob Baltussen. "Mapping of Multiple Criteria for Priority Setting of Health Interventions: An Aid for Decision Makers." BMC Health Services Research 12 (2012): 454. 

95 Burns, Catherine E. "Does My Program Really Make a Difference? Program Evaluation Utilizing Aggregate Single‐Subject Data." American Journal of Evaluation 36, no. 2 (June 2015): 191‐203. 

96 Williams, I. "Receptive Rationing: Reflections and Suggestions for Priority Setters in Health Care." J Health Organ Manag 29, no. 6 (2015): 701‐10. 

97 Gard, Carol L., Peggy N. Flannigan, and Maureen Cluskey. "Program Evaluation: An Ongoing Systematic Process." Nursing Education Perspectives 25, no. 4 (Jul/Aug2004): 176‐9. 

98 Donnelly, Catherine, Lyn Shulha, Don Klinger, and Lori Letts. "Using Program Evaluation to Support Knowledge Translation in an Interprofessional Primary Care Team: A Case Study." BMC Family Practice 17 (2016). 

99 Rogowski, Wolf H., Scott D. Grosse, Jörg Schmidtke, and Georg Marckmann. "Criteria for Fairly Allocating Scarce Health‐Care Resources to Genetic Tests: Which Matter Most?" European Journal of Human Genetics : EJHG 22, no. 1 (Jan 2014): 25‐31. 

100 Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR 1999;48 (No. RR‐11) https://www.cdc.gov/eval/framework/index.htm 

101 Ubel, Peter A. "Why It's Not Time for Health Care Rationing." Hastings Center Report 45, no. 2 (2018‐01‐13 2015): 15‐19. 

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Chapter 7. Conclusion

An organization’s moral agency assigns its ethical obligation to protect the human right

to health care, based in the foundations of equity, respect for human vulnerability and social

responsibility. This obligation is particularly important to reduce social inequalities within health

care, based on social determinants of health including race, ethnicity, culture, socioeconomic

status, and access to health care. Health care organizations can start to address these issues by

using cultural competency and shared decision-making, but these tools must be incorporated into

a larger framework to promote health care equity within the confines of finite resources.

A framework of resource allocation puts the patient’s goals and values first, with

recommended interventions presented in response. Resource allocation can also be used be in a

broader sense when distributing specific finite resources. Based on obligations of moral agency,

health care organizations are ethically obligated provide this framework, guiding the actions of

its agents and protecting the human rights of the patients it serves.

The human right to quality health care provides the foundation for this framework.

Human rights are based on the dignity of humans and are essential for all individuals to self-

determine. Health is essential for humans to act freely and make choices about their lives and

what is important to them. The duties to health were further defined through this dissertation as

the right to quality health care. The right to quality health care is supported by principles of

equity, respect for human vulnerability and social responsibility.

The right to health care includes the availability, accessibility, acceptability and quality

outcomes. Realizing the right to health care includes the need for health care to be available. In

addition to being available, these resources need to be accessible. All persons need have

meaningful access to health care to realize the right to health. In addition to being available and

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accessible, these resources must also be acceptable. Acceptability means that health care must

include the services that are needed to the level of quality that is needed to promote and protect

the right to health. Further, available, accessible, acceptable quality health care must be provide

with respect to equity. This involves both horizontal and vertical equity. Horizontal equity

explains that those with equal needs should be treated equally, while vertical equity explains that

those with differing needs should be treated differently.

Health care is a human right based on respect for human vulnerability and social

responsibility in health care. The nature of human vulnerability explains that all humans are

vulnerable, which means that all humans are at risk of poor health. Special vulnerability is also

an important concept for the respect for human rights. Special vulnerability explains that some

humans are more vulnerable than others based on individual or group characteristics. Special

vulnerability can be permanent or temporary. Social responsibility also provides support for

health care as a human right. Health care is social in nature, and can be defined as a social good.

Health care organizations should provide equitable, quality health care based on their social

responsibility.

Health care quality is a function of human rights because it is needed for humans to

meaningfully exercise other rights and freedoms, and vice versa. This right to quality health care

should include care quality, patient experience, patient safety and cost concerns. These facets of

quality should be incorporated into human rights protections with the goal of reducing disparities

in health care. The human right to quality health care defines standards of care that should be

protected, which is a needed clarification to existing human rights discourse. Clarity is needed on

roles and responsibilities related to the protection and promotion of the human right to health.

The human right to health is carried out by health care organizations since it requires that

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individuals have access to the highest quality of health care possible in the context of available

resources. The realization of this right to quality health care can be measured quality process and

outcomes, plus patient safety, patient satisfaction and costs to the health care system.

Quality health care is essential for humans to thrive and to realize other rights.

Standardization and accountability of human rights protections are needed to reduce health

disparities and protect health equity. The obligations of health care delivery organizations

include responsibilities for creating and sustaining quality health care, including measures of

outcomes, process, satisfaction or cost. Health care delivery organizations must also address

structures of inequality that influence quality and patient safety.

Social determinants of health – including race, ethnicity, culture, socioeconomic status

and barriers to access – have a serious impact on health outcomes in the United States.

Addressing these issues in the United States is especially challenging due to the multicultural

nature of the US population. Factors such as race, ethnicity and culture can have a significant

impact on health care access and outcomes. For example, Asian Americans patients can face

barriers to access based on language incongruity and discrimination.1 American Indians and

Alaskan Natives face barriers to quality health care as compared to non-Hispanic whites for

various reasons including cultural traditions, perceptions of bias, provider communication,

mistrust, beliefs and attitudes about care, cost, and continuity of care.2 Racial differences have

been demonstrated in breast cancer treatment and outcomes, where black women have

experienced worse outcomes than white women.3 In addition, geographical differences can

create significant barriers to access. Individuals who live in rural communities face significant

barriers to health care access independent of race, ethnicity and socioeconomic status.4 There are

countless examples of health disparities resulting from social determinants of health. This issue

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will only gain importance as racial and ethnic diversity in the United States will continue to

increase over the next 50 years.5 These demographic trends will place growing pressure on

health care systems to address human rights concerns related to the policy, financing and

delivery of equitable health care. Although national policy and health care financing have a clear

role in addressing these disparities, health care delivery organizations will have a special

responsibility to promote equitable access based on their moral agencies.

The role of the health care delivery organization is based on its moral agency. The moral

agency of a health care delivery organization requires a commitment to protect the human right

to quality health care. The importance of this commitment is related to the finite nature of health

care resources and the implication for health equity. Health care delivery organizations can use

tools within an ethical framework to promote health equity and protect health and human rights –

especially the tools of shared decision-making and cultural competency.

The moral agency of health care delivery organizations requires that they protect the

human right to health. This moral agency describes how the organization enacts its goals and

values of providing safe, quality care. The mission and values of a health care organization

describe the moral identity of a health care organization. The obligations of health care

organizations include promotion of quality care and protection of patient safety in respect of the

right to quality health care. A health care’s agents carry out and embody its moral identity.

Agents enact the moral identity of the organization. Quality, patient safety, and medical error are

closely related.

Due to the nature of health care delivery, health care delivery organizations have moral

responsibilities to protect the right to quality health care. This is explained by the express moral

agency of health care delivery organizations. The moral agency of health care delivery

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organizations is based on its ability to take collective moral action, and face collective moral

retribution based on those actions. Organizations that can face punishment-as-retribution

demonstrate rational agency since responsibility and punishment for corporate actions require the

ability to analyze corporate actions as moral. 6 Health care organizations can face collective

consequences of actions (rather than singular agents blamed for actions of the organization,) due

to the collective organization and resources behind those actions.7 The ability to assess and

penalize an organization for collective action demonstrates its independent moral agency.

Organizations have obligations to promote and protect quality health care and patient safety,

based on their role in carrying out the human right to health. The organization itself is the driver

of quality health care, based on these traits. Organizations should also monitor quality outcomes

to promote continuous quality assurance and improvement.

The health care organization should use an integrated approach to addressing issues

related to quality in health care. Health care quality encompasses the interconnected components

of the health care organization. These components cannot be separated and need to be addressed

as at the whole organization level to adequately address health care quality. This moral agency is

relevant to health care delivery organizations due to the nature of health care delivery services. A

health care delivery organization clearly fulfills duties to the interests of others through

organizational actions.8 In other words, the purpose of the health care delivery organization is to

serve the interests of others. A health care delivery organization has collective integrity since it

meets the needs of many and not just the few through its commitments, conduct, content,

context, consistency, coherence and continuity.9 A health care delivery organization is a moral

agent due to the moral obligations that result from this collective integrity.

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Shared decision-making can provide a platform for health care delivery systems to

address the common ground between physician and patient while respecting individualized

needs. This process can be facilitated through informing and involving the patient and ensuring

that the patient has adequate decision-making influence.10 This can be difficult for organizations

to effectively facilitate. Barriers to shared decision-making can include time pressure, frequent

alternation of physicians, and poor coordination.11 Shared decision-making requires a conscious

organizational commitment and resources to ensure the support and success of this process.

Shared decision-making is also closely connected to patient-centered care. The patient, including

the patient’s unique goals and values are at the center of health care decision-making. The

respect for human vulnerability and the social responsibility of health care share a focus on

responsibilities to individual patients, as well as patient populations within health care delivery.

Patient-centered care and shared decision-making can also enhance the effectiveness and

legitimacy of the informed consent process.

In addition, organizations should cultivate cultural competency at all levels of decision-

making to facilitate shared decision-making and health equity. Cultural competency involves an

ability to interact with those who are culturally different from oneself with a consideration for

cultural beliefs, practices, communication patterns, and health-seeking behaviors.12 Cultural

competence enables culturally appropriate decision-making processes and encourages dialogue

about health behaviors and biases that may adversely affect health disparities. Cultural

competency is a tool that can be used by the organization to address ethical challenges of a

multicultural society. It can help to address the social determinants of health including race,

ethnicity, culture, socioeconomic status, and access. Social determinants of health can and should

be addressed through cultural competency programs within health care organizations. Factors

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that affect social determinants of health such as culture, ethnicity, and race will be more

adequately addressed when an organization has an effective cultural competency program.

While shared decision-making and cultural competency can help health care delivery

organizations address the burdens of health inequity, these two tools alone will not fully protect

this right. These two tools, instead, should be integrated into a comprehensive framework in

which health care delivery organizations can protect human rights and fulfil their responsibilities

as moral agents. Presently, health care organizations lack a commonly accepted framework for

assessing benefits and prioritizing resources to protect equitable health care access. There is a

need for a framework focused on resource allocation with the intent of setting priorities within

the confines of limited health care resources. Cultural competency and shared decision-making

are important tools to promote health equity and human rights but, especially within the context

of finite healthcare resources, health care organizations need additional and even more robust

guidelines for addressing inequalities.

Health care delivery organizations have an obligation to protect the human right to health

based on their moral agency. This includes an obligation to protect the nature of human

vulnerability and honor their social responsibility. More specifically, health care organizations

must promote equitable quality health care, but this creates major challenges for health care

organizations when resources are scarce or limited, as they are in the United States.

Since health care resources are finite but demand is virtually unlimited, some people may

not be afforded the resources they need for health care. There has been much debate on this issue

in terms of health care rationing. The definition and arguments for rationing have thus far been

inadequate responses to the problem of limited resources in health care. Health care rationing has

also caused conflict and barriers to meaningful national policy discussion about the limitations of

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health care resources. Because of this, no comprehensive healthcare resource allocation exists at

the national level. This creates challenges to health care delivery organizations who are left with

little guidance on how to allocate resources.

Even if there was national policy guidance for the allocation of resources, health care

delivery organizations would still face significant challenges to implementation based on the

variation of patient needs and payer mix that are unique to each delivery organization. Health

care delivery organizations have an obligation to engage in ethically sound approaches to

distribution of their limited resources. The process for these decisions should be founded in

justice with a consideration for value. The process should be equitable for all patients, regardless

of medically irrelevant characteristics such as race, ethnicity, culture, socioeconomic status and

geographical proximity to health care providers.

The debate on medical futility highlights the need for a health care delivery resource

allocation framework. When medical non-beneficial care is provided, resources are wasted and

patients suffer. The major purpose of medical futility assessment is to determine whether an

intervention should be limited or eliminated based on its lack of efficacy. This could be a helpful

approach to evaluating and identifying waste within the health care system but it meets ethical

challenge because it lacks normative criteria for assessment.

Shared decision-making and patient-centered care facilitated by health care delivery

organizations can help to address issues related to non-beneficial care. When systematically

supported and guided by organizational policy, shared decision-making and patient-centered care

can be used to identify patient values and goals, and then make recommendations that are aligned

with benefit to those values and goals. Through shared decision-making, nonbeneficial medical

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care should be eliminated, since the patient and provider will decide on a treatment that is

aligned with the patient’s goals and values.

The role of the health care delivery organization is to facilitate policy and practical

decision-making to protect the human right to health care through equitable allocation of

available health care resources. This is accomplished by instituting a framework that

incorporates a resource policy committee, stakeholder commentary on developed policy, bedside

decision-making and an option for the community that the delivery organization serves to

provide input on future policy development. The resource policy committee should fulfil three

major roles of analysis, policy development and education. Analysis should incorporate justice,

respect for human vulnerability, and the social responsibility of the delivery organization. Policy

development should utilize the accountability for reasonableness framework. Education should

support cultural competency, shared decision-making and multi-disciplinary collaboration.

Through this framework, ethical resource allocation will be supported within health care delivery

organizations.

1 Weng, Suzie S. PhD M. S. W., and Warren T. I. I. I. M. S. W. Wolfe. "Asian American Health Inequities: An Exploration of Cultural and Language Incongruity and Discrimination in Accessing and Utilizing the Healthcare System." International Public Health Journal 8, no. 2 (2016): 155‐67. 

2 Rutman, Shira M. P. H., Leslie PhD Phillips, and Aren M. U. P. Sparck. "Health Care Access and Use by Urban American Indians and Alaska Natives: Findings from the National Health Interview Survey (2006‐09)." Journal of Health Care for the Poor and Underserved 27, no. 3 (Aug 2016): 1521‐36. 

3 Akinyemiju, Tomi F., Neomi Vin‐Raviv, Daniel Chavez‐Yenter, Xueyan Zhao, and Henna Budhwani. "Race/Ethnicity and Socio‐Economic Differences in Breast Cancer Surgery Outcomes." Cancer Epidemiology 39, no. 5 (2015): 745‐51. 

4 Caldwell, Julia T., Chandra L. Ford, Steven P. Wallace, May C. Wang, and Lois M. Takahashi. "Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States." American Journal of Public Health 106, no. 8 (Aug 2016): 1463‐69. 

5 U.S. Census Bureau. “U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now.” (2012.) www.census.gov/newsroom/releases/archives/population/cb12‐243.html. 

6 Wilmot, Stephen. "Corporate Moral Responsibility: What Can We Infer from Our Understanding of Organizations?" Journal of Business Ethics 30, no. 2 (Mar 2001): 161‐69. 

7 Soares, C. "Corporate Versus Individual Moral Responsibility." Journal of Business Ethics 46, no. 2 (Aug 2003): 43‐50. 

8 Gowri, Aditi. "On Corporate Virtue." Journal of Business Ethics 70, no. 4 (Feb 2007): 391‐400. 

                                                            

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                                                                                                                                                                                                9 Maak, Thomas. "Undivided Corporate Responsibility: Towards a Theory of Corporate Integrity." Journal of Business Ethics 82, no. 2 (Oct 2008): 353‐68. 

10 Stacey, Gemma, Anne Felton, Ada Hui, Theo Stickley, Philip Houghton, Bob Diamond, Alastair Morgan, James Shutt, and Martin Willis. "Informed, Involved and Influential: Three Is of Shared Decision Making." Mental Health Practice (2014+) 19, no. 4 (Dec 2015): 31. 

11 Hahlweg, Pola, Martin Härter, Yvonne Nestoriuc, and Isabelle Scholl. "How Are Decisions Made in Cancer Care? A Qualitative Study Using Participant Observation of Current Practice." BMJ Open 7, no. 9 (2017). 

12 Kelley, Michele A. "Cultural Competency." In Encyclopedia of Health Services Research, edited by Ross M. Mullner, 270‐274. Thousand Oaks, CA: SAGE Publications, Inc., 2009. doi: 10.4135/9781412971942.n98. 

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Appendix A

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Appendix B

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Bibliography

18th World Medical Association General Assembly. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Helinski, Finland: World Medical Association, June 1964.

64th World Medical Association General Assembly. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Fortaleza, Brazil: World Medical Association, Oct 2013.

Abraham, Jean PhD, Brian M. D. Sick, Joseph M. H. A. Anderson, Andrea M. H. A. Berg, Chad M. H. A. Dehmer, Amanda M. H. A. Tufano, and Kevin T. Fache Marx. "Selecting a Provider: What Factors Influence Patients' Decision Making?" Journal of Healthcare Management 56, no. 2 (Mar/Apr 2011): 99-114; discussion 14-5.

Acharya, Lalatendu. Encyclopedia of Human Services and Diversity. Thousand Oaks, California: SAGE Publications, Inc., 2014.

Addario, Bonnie J., Ana Fadich, Jesme Fox, Linda Krebs, Deborah Maskens, Kathy Oliver, Erin Schwartz, Gilliosa Spurrier-Bernard, and Timothy Turnham. "Patient Value: Perspectives from the Advocacy Community." Expectations 21, no. 1 (Feb 2018): 57-63.

Adolphs, Ralph. "Cognitive Neuroscience of Human Social Behaviour." Nature Reviews. Neuroscience 4, no. 3 (Mar 2003): 165-78.

Agency for Healthcare Research and Quality. “The CAHPS Program.” CAHPS Home. Accessed May 19, 2015. https://www.cahps.ahrq.gov/about-cahps/cahps-program/index.html

Agency for Healthcare Research and Quality. “Tools and Resources.” Accessed January 13, 018. https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/index.html

Agency for Healthcare Research and Quality. Improving Healthcare Quality. September 2002. http://archive.ahrq.gov/research/findings/factsheets/errors-safety/improving-quality/improving-health-care-quality.pdf

Ahlstrom-Vij, Kristoffer. "Procedural Justice and the Problem of Intellectual Deference." Episteme 11, no. 4 (Dec 2014): 423-42.

Ahola-Launonen, Johanna. "The Evolving Idea of Social Responsibility in Bioethics." Cambridge Quarterly of Healthcare Ethics 24, no. 2 (Apr 2015): 204-13.

Akinyemiju, Tomi F., Neomi Vin-Raviv, Daniel Chavez-Yenter, Xueyan Zhao, and Henna Budhwani. "Race/Ethnicity and Socio-Economic Differences in Breast Cancer Surgery Outcomes." Cancer Epidemiology 39, no. 5 (2015): 745-51.

Page 296: An Ethical Framework for Organizational Resource

 

288

Alam, Rahul, Sudeh Cheraghi-Sohi, Maria Panagioti, Aneez Esmail, Stephen Campbell, and Efharis Panagopoulou. "Managing Diagnostic Uncertainty in Primary Care: A Systematic Critical Review." BMC Family Practice 18 (2017).

Altisent, Rogelio, Nieves Martín-Espildora, and Maria Teresa Delgado-Marroquín. "Health Care Ethics Consultation: Individual Consultant or Committee Model? Pros and Cons." American Journal of Bioethics 13, no. 2 (2018-01-13 2013): 25-27.

American College of Healthcare Executives. ACHE Code of Ethics. November 14, 2011. https://www.ache.org/abt_ache/code.cfm#organization

American College of Physicians. "Racial and Ethnic Disparities in Health Care, Updated 2010." Philadelphia, 2010.

American Medical Association. "Principles of Medical Ethics." AMA Code of Medical Ethics. June 1, 2001. Accessed May 19, 2015. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medica

Amirsadri, Alireza, Jaclynne Burns, Albert Pizzuti, and Cynthia L. Arfken. "Home-Based Telepsychiatry in Us Urban Area." Case Reports in Psychiatry (2017).

Anderson, L. M., S. C. Scrimshaw, M. T. Fullilove, J. E. Fielding, and J. Normand. "Culturally Competent Healthcare Systems. A Systematic Review." Am J Prev Med 24, no. 3 Suppl (2003): 68-79.

Angell, B., J. Pares, and G. Mooney. "Implementing Priority Setting Frameworks: Insights from Leading Researchers." Health Policy 120, no. 12 (Dec 2016): 1389-94.

Anhang Price, Rebecca, Marc N. Elliott, Paul D. Cleary, Alan M. Zaslavsky, and Ron D. Hays. "Should Health Care Providers Be Accountable for Patients' Care Experiences?" Journal of General Internal Medicine 30, no. 2 (Feb 2015): 253-56.

Annas, George J. "Human Rights." In Bioethics, edited by Bruce Jennings, 1612-18. Farmington Hills, MI: Macmillan Reference USA, 2014.

Ansell, Dominique, James A. G. Crispo, Benjamin Simard, and Lise M. Bjerre. "Interventions to Reduce Wait Times for Primary Care Appointments: A Systematic Review." BMC Health Services Research 17 (2017).

Antiel, Ryan M., Farr A. Curlin, Katherine M. James, and Jon C. Tilburt. "The Moral Psychology of Rationing among Physicians: The Role of Harm and Fairness Intuitions in Physician Objections to Cost-Effectiveness and Cost-Containment." Philosophy, Ethics and Humanities in Medicine 8, no. 1 (2013): 8-13.

Appelbaum, Paul S., Jessica W. Berg, and Charles W. Lidz. 2001. Informed Consent: Legal Theory and Clinical Practice (2nd Edition). Cary, NC, USA: Oxford University Press, USA. Ebook available through Gumberg Library.

Page 297: An Ethical Framework for Organizational Resource

 

289

Armstrong, Matthew H. M. D. M. A., Joseph K. M. D. J. D. Poku, and Christopher M. M. D. J. D. Burkle. "Medical Futility and Nonbeneficial Interventions: An Algorithm to Aid Clinicians." Mayo Clinic Proceedings 89, no. 12 (Dec 2014): 1599-607.

Arnason, Gardar. "The Role and Obligations of Ethicists as Members of Ethics Committees in Professional Organizations." AJOB Neuroscience 8, no. 1 (Jan-Mar 2017): 18-20.

Arnold, Denis G. "Corporate Moral Agency." Midwest Studies In Philosophy 30, no. 1 (2006): 279-91.

Arras, John D., and Elizabeth M. Fenton. "Bioethics & Human Rights: Access to Health-Related Goods." The Hastings Center Report 39, no. 5 (Sep/Oct 2009): 27-38.

Ashman, I, and Diana W. "For or against Corporate Identity? Personification and the Problem of Moral Agency." Journal of Business Ethics 76, no. 1 (Nov 2007): 83-95.

Austin, Wendy. "Moral Distress and the Contemporary Plight of Health Professionals." HEC Forum 24, no. 1 (Mar 2012): 27-38.

Bach, P. B., L. D. Cramer, J. L. Warren, and C. B. Begg. "Racial Differences in the Treatment of Early-Stage Lung Cancer." N Engl J Med 341, no. 16 (1999): 1198-205.

Badano, G. "If You're a Rawlsian, How Come You're So Close to Utilitarianism and Intuitionism? A Critique of Daniels's Accountability for Reasonableness." Health Care Anal (Mar 22 2017).

Bader, Michael D. M., Marnie Purciel, Paulette Yousefzadeh, and Kathryn M. Neckerman. "Disparities in Neighborhood Food Environments: Implications of Measurement Strategies." Economic Geography 86, no. 4 (2010): 409-30

Baghbanian, Abdolvahab BSc MSc PhD, and Ghazal B. S. M. P. H. Torkfar. "Economics and Resourcing of Complex Healthcare Systems." Australian Health Review 36, no. 4 (2012): 394-400.

Bail, K., and L. Grealish. "'Failure to Maintain': A Theoretical Proposition for a New Quality Indicator of Nurse Care Rationing for Complex Older People in Hospital." Int J Nurs Stud 63 (Nov 2016): 146-61.

Bailey, Zinzi D., Nancy Krieger, Madina Agénor, Jasmine Graves, Natalia Linos, and Mary T. Bassett. "Structural Racism and Health Inequities in the USA: Evidence and Interventions." The Lancet 389, no. 10077 (2017): 1453-63.

Baily, Mary Ann, Melissa Bottrell, Joannne Lynn, and Bruce Jennings. "A Hastings Center Special Report: The Ethics of Using Qi Methods to Improve Health Care Quality and Safety." The Hastings Center Report 36, no. 4 (2006): s1-s40.

Page 298: An Ethical Framework for Organizational Resource

 

290

Bal, Gaëlle, Elodie Sellier, Sandra D. Tchouda, and Patrice Francois. "Improving Quality of Care and Patient Safety through Morbidity and Mortality Conferences." Journal for Healthcare Quality 36, no. 1 (Jan/Feb 2014): 29-36.

Bambas, Lexi. "Integrating Equity into Health Information Systems: A Human Rights Approach to Health and Information." PLoS Medicine 2, no. 4 (Apr 2005): e102.

Bandini, Julia I., Andrew Courtwright, Angelika A. Zollfrank, Ellen M. Robinson, and Wendy Cadge. "The Role of Religious Beliefs in Ethics Committee Consultations for Conflict over Life-Sustaining Treatment." Journal of Medical Ethics 43, no. 6 (Jun 2017): 353.

Barina, Rachelle. "Ethics Outside of Inpatient Care: The Need for Alliances between Clinical and Organizational Ethics." HEC Forum 26, no. 4 (Dec 2014): 309-23.

Barnard, David. "Vulnerability and Trustworthiness: Polestars of Professionalism in Healthcare." Cambridge Quarterly of Healthcare Ethics 25, no. 2 (2017-03-21 2016): 288-300.

Barr, D. A., and S. F. Wanat. "Listening to Patients: Cultural and Linguistic Barriers to Health Care Access." Fam Med 37, no. 3 (Mar 2005): 199-204.

Barton, Amy J. PhD R. N. Faan, and Mary Beth Flynn PhD R. N. C. N. S. Ccns Faan Makic. "Technology and Patient Safety." Clinical Nurse Specialist 29, no. 3 (May/Jun 2015): 129.

Bayoumi, Ahmed M. "Equity and Health Services." Journal of Public Health Policy 30, no. 2 (2009): 176-82.

Beachamp, L and Childress JF. Principles of Biomedical Ethics, 7th Edition. Oxford University Press, 2013.

Beal, Anne C. "High-Quality Health Care: The Essential Route to Eliminating Disparities and Achieving Health Equity." Health Affairs 30, no. 10 (2011): 1868-71.

Beard, J. R., N. Tomaska, A. Earnest, R. Summerhayes, and G. Morgan. "Influence of Socioeconomic and Cultural Factors on Rural Health." Australian Journal of Rural Health 17, no. 1 (2009): 10-15 6p.

Bennett, Belinda. "Introduction: Health and Human Rights." International Journal of Law in Context 7, no. 3 (Sep 2011): 271-72.

Berlin, Elois Ann, and William C. Fowkes. "A Teaching Framework for Cross-Cultural Health Care—Application in Family Practice." Western Journal of Medicine 139, no. 6 (1983): 934-38.

Betancourt, J. R., J. Corbett, and M. R. Bondaryk. "Addressing Disparities and Achieving Equity: Cultural Competence, Ethics, and Health-Care Transformation." Chest 145, no. 1 (Jan 2014): 143-48.

Page 299: An Ethical Framework for Organizational Resource

 

291

Betancourt, Joseph R. "Improving Quality and Achieving Equity: The Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care." 2006.

Betancourt, Joseph R., Alexander R. Green, and J. Emilio Carrillo. "Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches." The Commonwealth Fund, 2002.

Betancourt, Joseph R., Alexander R. Green, and J. Emilio Carrillo. "Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches." The Commonwealth Fund, 2002.

Betancourt, Joseph R., Sarah Beiter, and Alden Landry. "Improving Quality, Achieving Equity, and Increasing Diversity in Healthcare: The Future Is Now." Journal of Best Practices in Health Professions Diversity: Education, Research & Policy 6, no. 1 (Spring 2013): 903-17.

Bierhoff, H.W., R.L. Cohen, and J. Greenberg. Justice in Social Relations. Springer US, 2013. 211-219

Birmingham, Patricia, Martha D. Buffum, Mary A. Blegen, and Audrey Lyndon. "Handoffs and Patient Safety: Grasping the Story and Painting a Full Picture." Western Journal of Nursing Research 37, no. 11 (Nov 2015): 1458.

Blackhall, L. J., G. Frank, S. T. Murphy, V. Michel, J. M. Palmer, and S. P. Azen. "Ethnicity and Attitudes Towards Life Sustaining Technology." Soc Sci Med 48, no. 12 (1999): 1779-89.

Blacksher, Erika, and John R. Stone. "Introduction to Vulnerability Issues of Theoretical Medicine and Bioethics." Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice 23, no. 6 (2017-03-21 2002): 421-24.

Blanchard, Jeremy "Applying the Risk Discernment Process." Physician Leadership Journal 2, no. 1 (Jan/Feb 2015): 36-39.

Block, Dale "Revisiting the Triple Aim-Are We Any Closer to Integrated Health Care?" Physician Executive 40, no. 1 (Jan/Feb 2014): 40-3.

Boardman, Anne, Joanne Wilkinson, and Ruth Board. "Patient Satisfaction with Telephone Follow up after Treatment." Cancer Nursing Practice (2014+) 14, no. 9 (Nov 2015): 27.

Bonevski, Billie, Madeleine Randell, Chris Paul, Kathy Chapman, Laura Twyman, Jamie Bryant, Irena Brozek, and Clare Hughes. "Reaching the Hard-to-Reach: A Systematic Review of Strategies for Improving Health and Medical Research with Socially Disadvantaged Groups." BMC Medical Research Methodology 14 (20144): 42.

Bosch-Capblanch, Xavier, Zuske Meike-Kathrin, and Christian Auer. "Research on Subgroups Is Not Research on Equity Attributes: Evidence from an Overview of Systematic Reviews on Vaccination." International Journal for Equity in Health 16 (2017).

Page 300: An Ethical Framework for Organizational Resource

 

292

Bowers, John. "Balancing Operating Theatre and Bed Capacity in a Cardiothoracic Centre." Health Care Management Science 16, no. 3 (Sep 2013): 236-44.

Brach, C., and I. Fraser. "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model." Med Care Res Rev 57 Suppl 1 (2000): 181-184.

Brach, C., and I. Fraser. "Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case." Qual Manag Health Care 10, no. 4 (2002): 15-28.

Brandão, Cristina, Guilhermina Rego, Ivone Duarte, and Rui Nunes. "Social Responsibility: A New Paradigm of Hospital Governance? Health Care Analysis 21, no. 4 (2013): 390-402.

Brandis, Susan, Stephanie Schleimer, and John Rice. "Bricks-and-Mortar and Patient Safety Culture." Journal of Health Organization and Management 31, no. 4 (2017): 459-70.

Brännmark, Johan. "Respect for Persons in Bioethics: Towards a Human Rights-Based Account." Human Rights Review 18, no. 2 (Jun 2017): 171-87.

Braveman, P. "What Are Health Disparities and Health Equity? We Need to Be Clear." Public Health Rep 129 Suppl 2 (Jan-Feb 2014): 5-8.

Braveman, P. "What Is Health Equity: And How Does a Life-Course Approach Take Us Further toward It?" Matern Child Health J 18, no. 2 (Feb 2014): 366-72.

Braveman, P., and S. Gruskin. "Poverty, Equity, Human Rights and Health." Bull World Health Organ 81, no. 7 (2003): 539-45.

Braveman, PA. et al. "Health Disparities and Health Equity: The Issue Is Justice." American Journal of Public Health 101, no. S1 (2011): S149-55.

Braveman, Paula. "What Is Health Equity: And How Does a Life-Course Approach Take Us Further toward It?" Maternal and Child Health Journal 18, no. 2 (Feb 2014): 366-72.

Brennan, Niamh M., and Maureen A. Flynn. "Differentiating Clinical Governance, Clinical Management and Clinical Practice." Clinical Governance 18, no. 2 (2013): 114-31.

Brett, Allan S, and Laurence B. McCullough. "Addressing Requests by Patients for Nonbeneficial Interventions." JAMA 307, no. 2 (2012 Jan 11): 149-50.

Brock, D. W. "Ethical and Value Issues in Insurance Coverage for Cancer Treatment." Oncologist 15 Suppl 1 (2010): 36-42.

Brody, Howard "From an Ethics of Rationing to an Ethics of Waste Avoidance." The New England Journal of Medicine 366, no. 21 May 2012): 1949-51.

Brudney, D. "Is Health Care a Human Right?" Theor Med Bioeth 37, no. 4 (Aug 2016): 249-57.

Page 301: An Ethical Framework for Organizational Resource

 

293

Buchholz, RA, and Rosenthal, SB. "Integrating Ethics All the Way Through: The Issue of Moral Agency Reconsidered." Journal of Business Ethics 66, no. 2/3 (2006): 233-39.

Bunn, Frances, Claire Goodman, Jill Manthorpe, Marie-Anne Durand, Isabel Hodkinson, Greta Rait, Paul Millac, et al. "Supporting Shared Decision-Making for Older People with Multiple Health and Social Care Needs: A Protocol for a Realist Synthesis to Inform Integrated Care Models." BMJ Open 7, no. 2 (2017).

Burgess, Diana Jill, Megan Crowley-Matoka, Sean Phelan, John F. Dovidio, Robert Kerns, Craig Roth, Somnath Saha, and Michelle van Ryn. "Patient Race and Physicians' Decisions to Prescribe Opioids for Chronic Low Back Pain." Social Science & Medicine 67, no. 11 (2008): 1852-60.

Burke, Nancy J., Tessa M. Napoles, Priscilla J. Banks, Fern S. Orenstein, Judith A. Luce, and Galen Joseph. "Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients." PLoS One 11, no. 12 (Dec 2016).

Burnham, J. M., F. Meta, V. Lizzio, E. C. Makhni, and K. J. Bozic. "Technology Assessment and Cost-Effectiveness in Orthopedics: How to Measure Outcomes and Deliver Value in a Constantly Changing Healthcare Environment." Curr Rev Musculoskelet Med 10, no. 2 (Jun 2017): 233-39.

Burns, Catherine E. "Does My Program Really Make a Difference? Program Evaluation Utilizing Aggregate Single-Subject Data." American Journal of Evaluation 36, no. 2 (June 2015): 191-203.

Businelle, Mills, K. G. Chartier, D. E. Kendzor, J. M. Reingle, and K. Shuval. "Do Stressful Events Account for the Link between Socioeconomic Status and Mental Health?" J Public Health (Oxf) 36, no. 2 (Jun 2014): 205-12.

Bustreo, Flavia, and Paul Hunt. "The Right to Health Is Coming of Age: Evidence of Impact and the Importance of Leadership." Journal of Public Health Policy 34, no. 4 (Nov 2013): 574-9.

Byskov, J., B. Marchal, S. Maluka, J. M. Zulu, S. A. Bukachi, A. K. Hurtig, A. Blystad, et al. "The Accountability for Reasonableness Approach to Guide Priority Setting in Health Systems within Limited Resources--Findings from Action Research at District Level in Kenya, Tanzania, and Zambia." Health Res Policy Syst 12 (Aug 20 2014): 49.

Byskov, Jens, Bruno Marchal, Stephen Maluka, Joseph M. Zulu, Salome A. Bukachi, Anna-Karin Hurtig, Astrid Blystad, et al. "The Accountability for Reasonableness Approach to Guide Resource allocation in Health Systems within Limited Resources - Findings from Action Research at District Level in Kenya, Tanzania, and Zambia." Research Policy and Systems 12 (2014): 49.

Cady, Steven H., Jane V. Wheeler, Jeff DeWolf, and Michelle Brodke. "Mission, Vision, and Values: What Do They Say?" Organization Development Journal 29, no. 1 (Spring 2011): 63-78.

Page 302: An Ethical Framework for Organizational Resource

 

294

Caldwell, Julia T., Chandra L. Ford, Steven P. Wallace, May C. Wang, and Lois M. Takahashi. "Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States." American Journal of Public Health 106, no. 8 (Aug 2016): 1463-69.

Callahan, Daniel. "Rationing: Theory, Politics, and Passions." The Hastings Center Report 41, no. 2 (Mar/Apr 2011): 23-7.

Calloway, S. J. "The Effect of Culture on Beliefs Related to Autonomy and Informed Consent." Journal of Cultural Diversity 16, no. 2 (Summer 2009): 68-70 3p.

Carrillo, J. E., A. R. Green, and J. R. Betancourt. "Cross-Cultural Primary Care: A Patient-Based Approach." Ann Intern Med 130, no. 10 (1999): 829-34.

Carrillo, J. Emilio, Victor Carrillo, Hector R. B. A. Perez, Debbie M. Salas-Lopez, Ana Natale-Pereira, and Alex Byron. "Defining and Targeting Health Care Access Barriers." Journal of Health Care for the Poor and Underserved 22, no. 2 (May 2011): 562-75.

Cassie Cunningham, Goedken, Jane Moeckli, Peter M. Cram, and Reisinger Heather Schacht. "Introduction of Tele-Icu in Rural Hospitals: Changing Organisational Culture to Harness Benefits." Intensive & Critical Care Nursing 40 (2017): 51-56.

Castlen, J. P., D. J. Cote, W. A. Moojen, P. A. Robe, N. Balak, J. Brennum, M. Ammirati, T. Mathiesen, and M. L. D. Broekman. "The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice." World Neurosurg 102 (Jun 2017): 420-24.

Cauley, C. E., S. D. Block, L. A. Koritsanszky, J. D. Gass, J. L. Frydman, S. M. Nurudeen, R. E. Bernacki, and Z. Cooper. "Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study." J Palliat Med 19, no. 5 (May 2016): 529-37.

Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR 1999;48 (No. RR-11) https://www.cdc.gov/eval/framework/index.htm

Centers for Medicare and Medicaid Services. “Outcomes.” Accessed January 13, 2018. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/OutcomeMeasures.html

Chapman, Audrey R., and Benjamin Carbonetti. "Human Rights Protections for Vulnerable and Disadvantaged Groups: The Contributions of the Un Committee on Economic, Social and Cultural Rights." Human Rights Quarterly 33, no. 3 (Aug 2011): 682-732,922-23.

Charlesworth, M. "Don't Blame the 'Bio'--Blame the 'Ethics': Varieties of (Bio)Ethics and the Challenge of Pluralism." J Bioeth Inq 2, no. 1 (2005): 10-7.Chassin, Mark, Jerod M. Loeb, Stephen P. Schmaltz, and Robert M. Wachter. "Accountability Measures -- Using Measurement to Promote Quality Improvement." The New England Journal of Medicine 363, no. 7 (2010): 683-8.

Page 303: An Ethical Framework for Organizational Resource

 

295

Chatfield, J. Seth, Clinton O. Longenecker, Laurence S. Fink, and Jeffrey PGold. "Ten Ceo Imperatives for Healthcare Transformation: Lessons from Top-Performing Academic Medical Centers." Journal of Healthcare Management 62, no. 6 (Nov/Dec 2017): 371-83.

Chen, Jie, Daniel C. Mullins, Priscilla Novak, and Stephen B. Thomas. "Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities." Health Education & Behavior 43, no. 1 (February 2016): 25-34.

Cheshire, William P. J. R. M. D. "Telemedicine and the Ethics of Medical Care at a Distance." Ethics & Medicine 33, no. 2 (Summer 2017): 71-75,67.

Chin, J. L. "Culturally Competent Health Care." Public Health Reports 115, no. 1 (2000): 25-33.

Christiansen, Isaac. "Commodification of Healthcare and Its Consequences." World Review of Political Economy 8, no. 1 (Spring 2017): 82-103.

Citrin, Levi J. D., and Richard M. D. Blath. "Critical Management Tools for Getting Costs under Control." Physician Executive 39, no. 6 (Nov/Dec 2013): 28-31.

Clough, Juliana, Sunmin ScD Lee, and David H. Chae. "Barriers to Health Care among Asian Immigrants in the United States: A Traditional Review." Journal of Health Care for the Poor and Underserved 24, no. 1 (Feb 2013): 384-403.

Cohen, Alan B. "The Debate over Health Care Rationing: Déjà Vu All over Again?" Inquiry - Excellus Health Plan 49, no. 2 (Summer 2012): 90-100.

Collie, Therese, Bradley Graham, and Beverley A. Sparks. "Fair Process Revisited: Differential Effects of Interactional and Procedural Justice in the Presence of Social Comparison Information." Journal of Experimental Social Psychology 38, no. 6 (Nov 2002): 545-55.

Collins, Karen Scott, Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and K. Tenney. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey." 2002.

Committee on Quality Health Care in America, Institute of Medicine. Crossing The Quality Chasm : a New Health System for the 21st Century. Washington, D.C. :National Academy Press (2001): 5-6

Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, CD: National Academy Press, 2001. http://www.nap.edu/html/quality_chasm/report

Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system. Washington, D.C.: National Academy Press. (2000): 26.

Constitution of the World Health Organization . Geneva: World Health Organization; 1948.

Page 304: An Ethical Framework for Organizational Resource

 

296

Cooper, A. Joglekar, J. Gibson, A. H. Swota, and D. K. Martin. "Communication of Bed Allocation Decisions in a Critical Care Unit and Accountability for Reasonableness." BMC Health Serv Res 5 (Oct 31 2005): 67.

Cooper, L. A., T. S. Purnell, C. A. Ibe, J. P. Halbert, L. R. Bone, K. A. Carson, D. Hickman, et al. "Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities." Ethn Dis 26, no. 3 (Jul 21 2016): 369-78.

Cooper, Z., A. Courtwright, A. Karlage, A. Gawande, and S. Block. "Pitfalls in Communication That Lead to Nonbeneficial Emergency Surgery in Elderly Patients with Serious Illness: Description of the Problem and Elements of a Solution." Ann Surg 260, no. 6 (Dec 2014): 949-57.

Cosgrove, Delos M., Michael Fisher, Patricia Gabow, Gary Gottlieb, George C. Halvorson, Brent C. James, Gary S. Kaplan, et al. "Ten Strategies to Lower Costs, Improve Quality, and Engage Patients: The View from Leading Health System Ceos." Health Affairs 32, no. 2 (Feb 2013): 321-7.

Costa-Font, J., J. R. Forns, and A. Sato. "Participatory Health System Priority Setting: Evidence from a Budget Experiment." Soc Sci Med 146 (Dec 2015): 182-90.

Council for International Organizations of Medical Sciences (CIOMS) & World Health Organization (WHO) “International Ethical Guidelines for Biomedical Research Involving Human Subjects.” Geneva: 2002.

Council for International Organizations of Medical Sciences. International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva: 2002.

Courtwright, Andrew. "Who Is "Too Sick to Benefit" The Hastings Center Report 42, no. 4 (Jul/Aug 2012): 41-7.

Cromwell, I., S. J. Peacock, and C. Mitton. "'Real-World' Health Care Priority Setting Using Explicit Decision Criteria: A Systematic Review of the Literature." BMC Health Serv Res 15 (Apr 17 2015): 164.

Cummings, A., S. Lund, N. Campling, C. R. May, A. Richardson, and M. Myall. "Implementing Communication and Decision-Making Interventions Directed at Goals of Care: A Theory-Led Scoping Review." BMJ Open 7, no. 10 (Oct 6 2017): e017056.

Cundiff, Jenny M., Timothy W. Smith, Carolynne E. Baron, and Bert N. Uchino. "Hierarchy and Health: Physiological Effects of Interpersonal Experiences Associated with Socioeconomic Position." Health Psychology 35, no. 4 (2016): 356-65 11p.

Curtis, Andrew J., and Wei-An Andy Lee. "Spatial Patterns of Diabetes Related Health Problems for Vulnerable Populations in Los Angeles." International Journal of Health Geographics 9 (2010): 43.

Page 305: An Ethical Framework for Organizational Resource

 

297

Curtis, J. R., R. A. Engelberg, and J. M. Teno. "Understanding Variability of End-of-Life Care in the Icu for the Elderly." Intensive Care Med 43, no. 1 (Jan 2017): 94-96.

Daly, Bobby, and Elizabeth A. Mort. "A Decade after to Err Is Human: What Should Health Care Leaders Be Doing?" Physician Executive 40, no. 3 (2014): 50-2, 54.

Daniels, N. "Accountability for Reasonableness." Bmj 321, no. 7272 (Nov 25 2000): 1300-1.

Daniels, N. "Decisions About Access to Health Care and Accountability for Reasonableness." J Urban Health 76, no. 2 (Jun 1999): 176-91.

Daniels, Norman, “Justice, Health and Health Care,” in Medicine and Social Justice: Essays on the Distribution of Health Care, edited by Rhodes, Rosamond et. al. Oxford: Oxford University Press, 2012: 17-20.

Davies, Ben. "Fair Innings and Time-Relative Claims." Bioethics 30, no. 6 (2018-01-13 2016): 462-68.

Davila, Fidel. "The Infinite Costs of Futile Care-the Ultimate Physician Executive Challenge." Physician Executive 32, no. 1 (Jan/Feb 2006): 60-3.

Davis, Michael. Professional Codes. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd. London: SAGE Publications Ltd., 2011. http://dx.doi.org/10.4135/9781446200971.

Day, Lisa. "Distributive Justice and Personal Responsibility for Choices About Health." American Journal of Critical Care 15, no. 1 (Jan 2006): 96-8.

de Felice, Damiano. "Business and Human Rights Indicators to Measure the Corporate Responsibility to Respect: Challenges and Opportunities." Human Rights Quarterly 37, no. 2 (May 2015 2015): 511-555.

de Groot, F., S. Capri, J. C. Castanier, D. Cunningham, B. Flamion, M. Flume, H. Herholz, et al. "Ethical Hurdles in the Prioritization of Oncology Care." Appl Health Econ Health Policy 15, no. 2 (Apr 2017): 119-26.

Decety, J., and J. M. Cowell. "Empathy, Justice, and Moral Behavior." AJOB Neurosci 6, no. 3 (2015): 3-14.

"Declaration of Professional Responsibility Medicine's Social Contract with Humanity." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2692. New York: Macmillan Reference USA, 2004.

Dekker, Sidney. Just Culture: Balancing Safety and Accountability. Burlington, VT: Ashgate Publishing Company, (2014.)1-10.

Page 306: An Ethical Framework for Organizational Resource

 

298

DeMartino, E. S., S. E. Wordingham, J. M. Stulak, B. A. Boilson, K. R. Fuechtmann, N. Singh, D. P. Sulmasy, O. E. Pajaro, and P. S. Mueller. "Ethical Analysis of Withdrawing Total Artificial Heart Support." Mayo Clin Proc 92, no. 5 (May 2017): 719-25.

Desmidt, S et al. "Looking for the Value of Mission Statements: A Meta-Analysis of 20 Years of Research." Management Decision 49, no. 3 (2011): 468-83.

Dessart, Francis. "Freedom and the Fundamental Right of the Human Being." International Journal of Communication Research 4, no. 3 (Jul-Sep 2014): 289-95.

Dharssi, Safiyya, Durhane Wong-Rieger, Matthew Harold, and Sharon Terry. "Review of 11 National Policies for Rare Diseases in the Context of Key Patient Needs." Orphanet Journal of Rare Diseases 12 (2017).

Dilworth-Anderson, Peggye, Geraldine Pierre, and Tandrea S. Hilliard. "Social Justice, Health Disparities, and Culture in the Care of the Elderly." Journal of Law, Medicine & Ethics 40, no. 1 (Spring2012): 26-32.

Dinda, Soumyananda. "Inclusive Growth through Creation of Human and Social Capital." International Journal of Social Economics 41, no. 10 (2014): 878-95.

Dobler, C. C., C. P. West, and V. M. Montori. "Can Shared Decision Making Improve Physician Well-Being and Reduce Burnout?" Cureus 9, no. 8 (Aug 27 2017): e1615.

Donnelly, Catherine, Lyn Shulha, Don Klinger, and Lori Letts. "Using Program Evaluation to Support Knowledge Translation in an Interprofessional Primary Care Team: A Case Study." BMC Family Practice 17 (2016).

Downar, James, Tracy Luk, Robert W. Sibbald, Tatiana Santini, Joseph Mikhael, Hershl Berman, and Laura Hawryluck. "Why Do Patients Agree to a "Do Not Resuscitate" or "Full Code" Order? Perspectives of Medical Inpatients." Journal of General Internal Medicine 26, no. 6 (Jun 20111): 582-7.

Dreachslin, Janice L. "Diversity Management and Cultural Competence: Research, Practice, and the Business Case." Journal of Healthcare Management 52, no. 2 (Mar/Apr 2007): 79-86.

Drewes, Y. M., J. W. Blom, W. J. Assendelft, T. Stijnen, W. P. den Elzen, and J. Gussekloo. "Variability in Vulnerability Assessment of Older People by Individual General Practitioners: A Cross-Sectional Study." PLoS One 9, no. 11 (2014): e108666.

Dubach, Barbara, and Maria Teresa Machado. "The Importance of Stakeholder Engagement in the Corporate Responsibility to Respect Human Rights." International Review of the Red Cross 94, no. 887 (Sep 2012): 1047-68.

Dudzinski, Denise M. "Commentary: In the Interest of Fairness." Cambridge Quarterly of Healthcare Ethics 22, no. 4 (Oct 2013): 401-2.

Page 307: An Ethical Framework for Organizational Resource

 

299

Duffy, William. "Improving Patient Safety by Practicing in a Just Culture." Association of Operating Room Nurses. AORN Journal 106, no. 1 (Jul 2017): 66-68.

Dunlay, S. M., and J. J. Strand. "How to Discuss Goals of Care with Patients." Trends Cardiovasc Med 26, no. 1 (Jan 2016): 36-43.

Durante, C. "Bioethics in a Pluralistic Society: Bioethical Methodology in Lieu of Moral Diversity." Med Health Care Philos 12, no. 1. 2009.

Dutta, Mohan J. "Reducing Health Disparities: Communication Interventions." In Reducing Health Disparities: Communication Interventions, edited by Gary L. Kreps, 1-14. Vol. 6. New York: Peter Lang Publishing, 2013.

Dzeng, E., A. Colaianni, M. Roland, D. Levine, M. P. Kelly, S. Barclay, and T. J. Smith. "Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study." J Gen Intern Med 31, no. 1 (Jan 2016): 93-9.

Edgar, Andrew, and Stephen Pattison. "Flourishing in Health Care." Health Care Analysis : HCA 24, no. 2 (Jun 2016): 161-73.

Eleftheriadis, Pavlos. "A Right to Health Care." 268-85: Wiley-Blackwell, 2012.

Eleftheriadis, Pavlos. "A Right to Health Care." 268-85: Wiley-Blackwell, 2012.

Engelman, Michal, Christopher L. Seplaki, and Ravi Varadhan. "A Quiescent Phase in Human Mortality? Exploring the Ages of Least Vulnerability." Demography 54, no. 3 (Jun 2017): 1097-118.

Epstein, Wendy Netter. "Nudging Patient Decision-Making." Washington Law Review 92, no. 3 (2017): 1255-315.

Erdman, Joanna N. "Human Rights in Health Equity: Cervical Cancer and Hpv Vaccines." American Journal of Law and Medicine 35, no. 2/3 (2009): 365-87.

Ernecoff, N. C., F. A. Curlin, P. Buddadhumaruk, and D. B. White. "Health Care Professionals' Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care Discussions." JAMA Intern Med 175, no. 10 (Oct 2015): 1662-9.

Eva C. Winkler, Russell L. Gruen. Organizational Ethics. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd. London: SAGE Publications Ltd. (2011): 73-74.

Ewing, Michael. "The Patient-Centered Medical Home Solution to the Cost-Quality Conundrum." Journal of Healthcare Management 58, no. 4 (Jul/Aug 2013): 258-66.

Fagan, A. "Challenging the Bioethical Application of the Autonomy Principle within Multicultural Societies." J Appl Philos 21, no. 1 (2004): 15-31.

Page 308: An Ethical Framework for Organizational Resource

 

300

Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns Hopkins University Press. 2015 (2nd edition).

Farber Post, Linda, Jeffrey Blustein, and Nancy Neveloff Dubler. Handbook for health care ethics committees. Baltimore: Johns Hopkins University Press. 2015 (2nd edition).

Fariss, Christopher J. "Respect for Human Rights Has Improved over Time: Modeling the Changing Standard of Accountability." The American Political Science Review 108, no. 2 (May 2014): 297-318.

Farmer, P. Pathologies of Power. Health, Human Rights, and the New War on the Poor. Los Angeles: University of California Press, 2005. 157-159

Fasterling, Björn, and Geert Demuijnck. "Human Rights in the Void? Due Diligence in the Un Guiding Principles on Business and Human Rights." Journal of Business Ethics 116, no. 4 (Sep 2013): 799-814.

Felland, Laurie E., Paul B. Ginsburg, and Gretchen M. Kishbauch. "Improving Health Care Access for Low-Income People: Lessons from Ascension Health's Community Collaboratives." Health Affairs 30, no. 7 (Jul 2011): 290-8.

Fenton, Elizabeth, and John D. Arras. "Bioethics and Human Rights: Curb Your Enthusiasm." Cambridge Quarterly of Healthcare Ethics 19, no. 1 (Jan 2010): 127-33.

Fenton, JD and Fenton, EM. “Bioethics and Human Rights: Access to Health-Related Goods.” Hastings Center Report, Volume 39, Number 5, September-October, 2009, 27-38.

Fiester, Autumn. "Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure." The American Journal of Bioethics 15, no. 1 (2015): 29-36.

Fiscella, K. "Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions." Annals of Family Medicine 9, no. 1 (2011): 78-84.

Fiscella, K., P. Franks, M. P. Doescher, and B. G. Saver. "Disparities in Health Care by Race, Ethnicity, and Language among the Insured: Findings from a National Sample." Med Care 40, no. 1 (2002): 52-9.

Fiscella, K., P. Franks, M. R. Gold, and C. M. Clancy. "Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care." JAMA 283, no. 19 (2000): 2579- 84.

Fisher, Jill A. "Expanding the Frame of "Voluntariness" in Informed Consent: Structural Coercion and the Power of Social and Economic Context." Kennedy Institute of Ethics Journal 23, no. 4 (Dec 2013): 355-79.

FitzGerald, Chloe, and Samia Hurst. "Implicit Bias in Healthcare Professionals: A Systematic Review." BMC Medical Ethics 18 (2017).

Page 309: An Ethical Framework for Organizational Resource

 

301

Flaming, D. "Appropriate Ethics Review Is Required." Healthc Manage Forum 30, no. 1 (Jan 2017): 46-48.

Fleck, Leonard M. "Choosing Wisely." Cambridge Quarterly of Healthcare Ethics 25, no. 3 (Jul 2016): 366-76.

Fleck, Leonard M. "Just Caring: In Defense of Limited Age-Based Healthcare Rationing." Cambridge Quarterly of Healthcare Ethics 19, no. 1 (Jan 2010): 27-37.

Fleck, Leonard M. "The Costs of Caring: Who Pays? Who Profits? Who Panders?" The Hastings Center Report 36, no. 3 (May/Jun 2006): 13-7.

Fleming, David A. "The Moral Agency of Physician Organizations: Meeting Obligations to Advocate for Patients and the Public." Annals of Internal Medicine 163, no. 12 (2015): 918-21 4p.

Forehand, Aimee. "Mission and Organizational Performance in the Healthcare Industry." Journal of Healthcare Management 45, no. 4 (Jul/Aug 2000): 267-77.

Forman, L. "What Do Human Rights Bring to Discussions of Power and Politics in Health Policy and Systems?" Glob Public Health (Dec 13 2017): 1-14.

Fox, R. C., and J. P. Swazey. "Examining American Bioethics: Its Problems and Prospects." Camb Q Healthc Ethics 14, no. 4 (2005): 361-73.

Frader, Joel E., and Charles L. Bosk. "Mistakes, Medical." In Bioethics, edited by Bruce Jennings, 2107-13. Farmington Hills, MI: Macmillan Reference USA, 2014.

Frintner, M. P., F. S. Mendoza, B. P. Dreyer, W. L. Cull, and D. Laraque. "Resident CrossCultural Training, Satisfaction, and Preparedness." Acad Pediatr 13, no. 1 (2013): 65-71.

Frosch, Dominick L., Suepattra G. May, Katharine A. S. Rendle, Caroline Tietbohl, and Glyn Elwyn. "Authoritarian Physicians and Patients' Fear of Being Labeled 'Difficult' among Key Obstacles to Shared Decision Making." Health Affairs 31, no. 5 (May 2012): 1030-8.

Fung, Constance H., and Ron D. Hays. "Prospects and Challenges in Using Patient-Reported Outcomes in Clinical Practice." Quality of Life Research 17, no. 10 (Dec 2008): 1297-302.

Furumoto-Dawson, A., S. Gehlert, D. Sohmer, O. Olopade, and T. Sacks. "Early-Life Conditions and Mechanisms of Population Health Vulnerabilities." Health Affairs 26, no. 5 (2007): 1238-48.

Gabbay, E., J. Calvo-Broce, K. B. Meyer, T. A. Trikalinos, J. Cohen, and D. M. Kent. "The Empirical Basis for Determinations of Medical Futility." J Gen Intern Med 25, no. 10 (Oct 2010): 1083-9.

Page 310: An Ethical Framework for Organizational Resource

 

302

Gabbay, Ezra, Jose Calvo-broce, Klemens B. Meyer, Thomas A. Trikalinos, Joshua Cohen, and David M. Kent. "The Empirical Basis for Determinations of Medical Futility." Journal of General Internal Medicine 25, no. 10 (Oct 2010): 1083-9.

Galbiati, Roberto, and Pietro Vertova. "Horizontal Equity." Economica 75, no. 298 (2008): 384-91.

Gallagher, Colleen M., and Ryan F. Holmes. "Handling Cases of 'Medical Futility'." HEC Forum 24, no. 2 (Jun 2012): 91-8.

Gard, Carol L., Peggy N. Flannigan, and Maureen Cluskey. "Program Evaluation: An Ongoing Systematic Process." Nursing Education Perspectives 25, no. 4 (Jul/Aug2004): 176-9.

Gardner, Wendi L., and Kristy K. Dean. "Interdependent Self-Construals." In Encyclopedia of Social Psychology, edited by Roy F. Baumeister and Kathleen D. Vohs, 490-92. Thousand Oaks, CA: SAGE Publications, 2007.

Garvelink, Mirjam M., Julie Emond, Matthew Menear, Nathalie Briere, Adriana Freitas, Laura Boland, Maria Margarita Becerra Perez, et al. "Development of a Decision Guide to Support the Elderly in Decision Making About Location of Care: An Iterative, User-Centered Design." Research Involvement and Engagement 2 (2016).

Gauri, Varun. "The Cost of Complying with Human Rights Treaties: The Convention on the Rights of the Child and Basic Immunization." The Review of International Organizations 6, no. 1 (Mar 2011): 33-56.

Gavriloff, Carrie, Sarah Ostrowski-Delahanty, and Kimberly Oldfield. "The Impact of Lean Six Sigma Methodology on Patient Scheduling." Nursing Economics 35, no. 4 (Jul/Aug 2017): 189-93.

General Assembly resolution 70/1, Transforming Our World: The 2030 Agenda for Sustainable Development, A/RES/70/1 (25 September 2015.)

Geros-Willfond, K. N., S. S. Ivy, K. Montz, S. E. Bohan, and A. M. Torke. "Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults." J Relig Health 55, no. 3 (Jun 2016): 765-77.

Gibson, Jennifer L, Douglas K Martin, and Peter A Singer. "Setting Priorities in Health Care Organizations: Criteria, Processes, and Parameters of Success." BMC Health Services Research 4, no. 1, 2004. 4-25.

Glickman, Seth W., Kelvin A. Baggett, Christopher G. Krubert, Eric D. Peterson, and Kevin A. Schulman. "Promoting Quality: The Health-Care Organization from a Management Perspective." International Journal for Quality in Health Care 19, no. 6 (2007): 341-8.

Gluyas, Heather. "Patient-Centred Care: Improving Healthcare Outcomes." Nursing Standard (2014+) 30, no. 4 (2015): 50.

Page 311: An Ethical Framework for Organizational Resource

 

303

Gomes, Carlos F., Mahmoud M. Yasin, and Yousef Yasin. "Assessing Operational Effectiveness in Healthcare Organizations: A Systematic Approach." International Journal of Health Care Quality Assurance 23, no. 2 (2010): 127-40.

Gong, Yang, Song Hsing-Yi, Xinshuo Wu, and Lei Hua. "Identifying Barriers and Benefits of Patient Safety Event Reporting toward User-Centered Design." Safety in Health 1 (2015).

Goode, Tawara D., M. Clare Dunne, and Suzanne M. Bronheim. "The Evidence Base for Cultural and Linguistic Competency in Health Care." 2006.

Goold, Susan Dorr. "Trust and the Ethics of Health Care Institutions." The Hastings Center Report 31, no. 6 (2001): 26-33.

Gordon, J. S. "Global Ethics and Principlism." Kennedy Inst Ethics J 21, no. 3 (2011): 251-253.

Gowri, Aditi. "On Corporate Virtue." Journal of Business Ethics 70, no. 4 (Feb 2007): 391-400.

Graber, David R., and Anne Osborne Kilpatrick. "Establishing Values-Based Leadership and Value Systems in Healthcare Organizations." Journal of Health and Human Services Administration 31, no. 2 (Fall 2008): 179-97.

Grabovschi, Cristina, Christine Loignon, and Martin Fortin. "Mapping the Concept of Vulnerability Related to Health Care Disparities: A Scoping Review." BMC Health Services Research 13 (2013): 94.

Grande, Stuart W., Marie-anne Durand, Elliott S. Fisher, and Glyn Elwyn. "Physicians as Part of the Solution? Community-Based Participatory Research as a Way to Get Shared Decision Making into Practice." Journal of General Internal Medicine 29, no. 1 (Jan 2014): 219-22.

Green, C. R., K. O. Anderson, T. A. Baker, L. C. Campbell, S. Decker, R. B. Fillingim, D. A. Kalauokalani, et al. "The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain." Pain Med 4, no. 3 (2003): 277-94.

Green, M. J., and M. Benzeval. "The Development of Socioeconomic Inequalities in Anxiety and Depression Symptoms over the Lifecourse." Soc Psychiatry Psychiatr Epidemiol 48, no. 12 (Dec 2013): 1951-61.

Grill, K. "Incentives, Equity and the Able Chooser Problem." J Med Ethics 43, no. 3 (Mar 2017): 157-61.

Grill, Kalle. "Incentives, Equity and the Able Chooser Problem." Journal of Medical Ethics 43, no. 3 (Mar 2017): 157.

Gross, Aeyal. "Is There a Human Right to Private Health Care?" The Journal of Law, Medicine & Ethics 41, no. 1 (2013): 138-146.

Page 312: An Ethical Framework for Organizational Resource

 

304

Gruskin, S., and N. Daniels. "Process Is the Point: Justice and Human Rights: Priority Setting and Fair Deliberative Process." Am J Public Health 98, no. 9 (Sep 2008): 1573-7.

Gruskin, Sofia J. D. M. I. A., and Norman PhD Daniels. "Justice and Human Rights: Resource allocation and Fair Deliberative Process." American Journal of Public Health 98, no. 9 (Sep): 1573-7.

Gruskin, Sofia, Dina Bogecho, and Laura Ferguson. "'Rights-Based Approaches' to Health Policies and Programs: Articulations, Ambiguities, and Assessment." Journal of Public Health Policy 31, no. 2 (Jul 2010): 129-45.

Gruskin, Sofia. Perspectives on Health and Human Rights. New York: Routledge, 2005. 3-49

Gu, Y., E. Lancsar, P. Ghijben, J. R. Butler, and C. Donaldson. "Attributes and Weights in Health Care Priority Setting: A Systematic Review of What Counts and to What Extent." Soc Sci Med 146 (Dec 2015): 41-52.

Gulliford, Martin. "Modernizing Concepts of Access and Equity." Health Economics, Policy and Law 4, no. 2 (Apr 2009): 223-30.

Gunn, Jennifer L. "Meeting Rural Health Needs: Interprofessional Practice or Public Health?" Nursing History Review 24 (2016): 90-97.

Gupta, Digant, Mark Rodeghier, and Christopher G. Lis. "Patient Satisfaction with Service Quality as a Predictor of Survival Outcomes in Breast Cancer." Supportive Care in Cancer 22, no. 1 (Jan 2014): 129-34.

Gusmano, Michael K. "Access to Health Care." In Bioethics, edited by Bruce Jennings, 77-81. Farmington Hills, MI: Macmillan Reference USA, 2014.

Gusmano, Michael K. "Do We Really Want to Control Health Care Spending?" Journal of Health Politics, Policy & Law 36, no. 3 (2011): 495-500.

Gusmano, Michael K., Daniel Weisz, and Victor G. Rodwin. "Achieving Horizontal Equity: Must We Have a Single-Payer Health System?"Journal of Health Politics, Policy & Law 34, no. 4 (2009): 617-33.

Gustavsson, E., and L. Sandman. "Health-Care Needs and Shared Decision-Making in Priority-Setting." Med Health Care Philos 18, no. 1 (Feb 2015): 13-22.

Haghighinezhad, G., F. Atashzadeh-Shoorideh, T. Ashktorab, J. Mohtashami, and M. Barkhordari-Sharifabad. "Relationship between Perceived Organizational Justice and Moral Distress in Intensive Care Unit Nurses." Nurs Ethics (Jan 1 2017): 969733017712082.

Hahlweg, Pola, Martin Härter, Yvonne Nestoriuc, and Isabelle Scholl. "How Are Decisions Made in Cancer Care? A Qualitative Study Using Participant Observation of Current Practice." BMJ Open 7, no. 9 (2017).

Page 313: An Ethical Framework for Organizational Resource

 

305

Halabi, Sam. "Selling Hospice." The Journal of Law, Medicine & Ethics 42, no. 4 (December 2014): 442-54.

Hall, Robert T. "Organizational Ethics in Healthcare." In Encyclopedia of Bioethics, edited by Stephen G. Post, 1940-44. New York: Macmillan Reference USA, 2004.

Hall, Robert T. An Introduction to Healthcare Organizational Ethics. Oxford: Oxford University Press, 2000. 41-56.

Hamel, Mary Beth, Jennifer Prah Ruger, Theodore W. Ruger, and George J. Annas. "The Elusive Right to Health Care under U.S. Law." The New England Journal of Medicine 372, no. 26 (2015): 2558-63.

Hamilton, D. F., J. V. Lane, P. Gaston, J. T. Patton, D. MacDonald, A. H. R. W. Simpson, and C. R. Howie. "What Determines Patient Satisfaction with Surgery? A Prospective Cohort Study of 4709 Patients Following Total Joint Replacement”

Hamric, A. B., and E. G. Epstein. "A Health System-Wide Moral Distress Consultation Service: Development and Evaluation." HEC Forum 29, no. 2 (Jun 2017): 127-43.

Hanson, L. C., S. Zimmerman, M. K. Song, F. C. Lin, C. Rosemond, T. S. Carey, and S. L. Mitchell. "Effect of the Goals of Care Intervention for Advanced Dementia: A Randomized Clinical Trial." JAMA Intern Med 177, no. 1 (Jan 1 2017): 24-31.

Hardy, Jan, and Tina Barrows. "Key Concepts in Public Health: Vulnerability." London: SAGE Publications Ltd, 2009.

Harle, I., S. Karim, W. Raskin, W. M. Hopman, and C. M. Booth. "Toward Improved Goals-of-Care Documentation in Advanced Cancer: Report on the Development of a Quality Improvement Initiative." Curr Oncol 24, no. 6 (Dec 2017): 383-89.

Harris, C., K. Allen, C. Waller, and V. Brooke. "Sustainability in Health Care by Allocating Resources Effectively (Share) 3: Examining How Resource Allocation Decisions Are Made, Implemented and Evaluated in a Local Healthcare Setting." BMC Health Serv Res 17, no. 1 (May 9 2017): 340.

Harrison, Mark, Katherine Milbers, Marie Hudson, and Nick Bansback. "Do Patients and Health Care Providers Have Discordant Preferences About Which Aspects of Treatments Matter Most? Evidence from a Systematic Review of Discrete Choice Experiments." BMJ Open 7, no. 5 (2017).

Have, H. ten. Vulnerability: Challenging Bioethics. Abingdon, Oxon: Routledge, 2016.

Hawkins, Sara F., and Janice Faan Morse. "The Praxis of Courage as a Foundation for Care." Journal of Nursing Scholarship 46, no. 4 (Jul 2014): 263-70.

Hegtvedt, Karen A., and Jody Clay-Warner. Justice. Bradford, United Kingdom: Emerald Group Publishing Limited, 2008.

Page 314: An Ethical Framework for Organizational Resource

 

306

Helmig, Bernd, Vera Hinz, and Stefan Ingerfurth. "Valuing Organizational Values: Assessing the Uniqueness of Nonprofit Values." Voluntas: International Journal of Voluntary & Nonprofit Organizations 26, no. 6 (2015): 2554-80.

Hernandez, E. M. "Provider and Patient Influences on the Formation of Socioeconomic Health Behavior Disparities among Pregnant Women." Soc Sci Med 82 (Apr 2013): 35-42.

Hernandez, Jill Graper. "Human Value, Dignity, and the Presence of Others." HEC Forum 27, no. 3 (Sep 2015): 249-63.

Hessler, Kristen, and Allen Buchanan. "Equality, Democracy and the Human Right to Health Care." In Medicine and Social Justice: Essays on the Distribution of Health Care, Second ed. New York: Oxford University Press, 2012. 97-104.

Higgs, M., R. Fernandez, S. Polis, and V. Manning. "Similarities and Differences in Nurse-Reported Care Rationing between Critical Care, Surgical, and Medical Specialties." J Patient Saf (Nov 2 2016).

Hilmer, Sarah N., Danijela Gnjidic, and David G. Le Couteur. "Thinking through the Medication List: Appropriate Prescribing and Deprescribing in Robust and Frail Older Patients." Australian Family Physician 41, no. 12 (Dec 2012): 924-8.

Himmelstein, David U., and Steffie Woolhandler. "The Current and Projected Taxpayer Shares of Us Health Costs." American Journal of Public Health 106, no. 3 (2016): 449-52.

Hoffmaster, Barry. "What Does Vulnerability Mean?" Hastings Center Report 36, no. 2 (2017-03-21 2006): 38-45.

Hosseinpoor, Ahmad Reza, Nicole Bergen, and Anne Schlotheuber. "Promoting Health Equity: Who Health Inequality Monitoring at Global and National Levels." Global Health Action 8 (2015).

"How to Increase Socially Responsible Change." In Change Management Excellence, edited by Sarah Cook, Steve Macaulay and Hilary Coldicott, 210-14. London: Kogan Page, 2004.

Hsia, Renee Yuen-Jan, and Yu-Chu Shen. "Rising Closures of Hospital Trauma Centers Disproportionately Burden Vulnerable Populations." Health Affairs 30, no. 10 (Oct 2011): 1912-20.

Hsieh, Ching-Hsing. "A Concept Analysis of Social Capital within a Health Context." Nursing Forum 43, no. 3 (2008): 151-9.

Huesch, Marco D. "One and Done? Equality of Opportunity and Repeated Access to Scarce, Indivisible Medical Resources." BMC Medical Ethics 13 (2012): 11.

Huff, Robert M., Michael V. Kline, and Darleen V. Peterson, eds. Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. Third edition. ed. Thousand Oaks: Sage, 2015, chapter 1.

Page 315: An Ethical Framework for Organizational Resource

 

307

Hulshof, Peter J., Richard J. Boucherie, Erwin W. Hans, and Johann L. Hurink. "Tactical Resource Allocation and Elective Patient Admission Planning in Care Processes." Health Care Management Science 16, no. 2 (Jun 2013): 152-66.

Hunt, L. Inventing Human Rights. A History. New York/London: W.W. Norton & Company, 2008. 19-22

Hutchison, Lauren A., Donna S. Raffin-Bouchal, Charlotte A. Syme, Patricia D. Biondo, and Jessica E. Simon. "Readiness to Participate in Advance Care Planning: A Qualitative Study of Renal Failure Patients, Families and Healthcare Providers." Chronic Illness 13, no. 3 (Sep 2017): 171-87.

Huynh, T. N., E. C. Kleerup, P. P. Raj, and N. S. Wenger. "The Opportunity Cost of Futile Treatment in the Icu*." Crit Care Med 42, no. 9 (Sep 2014): 1977-82.

Hwang, Stephen W. M. D. M. P. H., Joanna J. M. B. A. Ueng, Shirley M. A. Chiu, Alex PhD Kiss, George PhD M. P. H. Tolomiczenko, Laura BScN Cowan, Wendy M. D. Levinson, and Donald A. M. D. Mshsr Redelmeier. "Universal Health Insurance and Health Care Access for Homeless Persons." American Journal of Public Health 100, no. 8 (Aug 2010): 1454-61.

Illhardt, Franz-Josef. "Conflict between a Patient's Family and the Medical Team." HEC Forum 19, no. 4 (Dec 2007): 381-8.

Iltis, Ana Smith,. "Values Based Decision Making: Organizational Mission and Integrity." HEC Forum 17, no. 1 (Mar 2005): 6-17.

Institute for Healthcare Improvement. “Patient Safety: Overview.” Accessed January 13, 2018. http://www.ihi.org/Topics/PatientSafety/Pages/Overview.aspx

International Bioethics Committee of UNESCO. On Social Responsibility and Health. 2010.

International Bioethics Committee: Report on Social Responsibility and Health. United Nations Educational, Scientific and Cultural Organization. France 2010.

International Bioethics Committee: Report on the Principle of Respect for Human Vulnerability and Human Integrity. United Nations Educational, Scientific and Cultural Organization. France 2013.

Iserson, Kenneth V. "Providing Ethical Healthcare in Resource-Poor Environments." HEC Forum (January 19 2018).

James, Brent C., and Lucy A. Savitz. "How Intermountain Trimmed Health Care Costs through Robust Quality Improvement Efforts.” Health Affairs 30, no. 6 (Jun 2011): 1185-91.

Jan Helge Solbakk: Vulnerability: A futile or useful principle in Healthcare Ethics? In: Ruth Chadwick, Henk ten Have and Eric M. Meslin (Eds): The SAGE Handbook of Health Care Ethics: Core and Emerging Issues. SAGE Publishers, Los

Page 316: An Ethical Framework for Organizational Resource

 

308

Jan, S. "Proceduralism and Its Role in Economic Evaluation and Priority Setting in Health." Soc Sci Med 108 (May 2014): 257-61.

Jansky, Maximiliane, Gabriella Marx, Friedemann Nauck, and Bernd Alt-Epping. "Physicians' and Nurses' Expectations and Objections toward a Clinical Ethics Committee." Nursing Ethics 20, no. 7 (Nov 2013): 771-83.

Jecker, N. S. "Doing What We Shouldn't: Medical Futility and Moral Distress." Am J Bioeth 17, no. 2 (Feb 2017): 41-43.

Jecker, Nancy S. "Justice." In Bioethics, edited by Bruce Jennings, 1774-84. Farmington Hills, MI: Macmillan Reference USA, 2014.

Jiang, H. Joanna PhD, Carlin Lockee, Karma Fache Bass, Irene PhD Fraser, and Eric P. Fache Norwood. "Board Oversight of Quality: Any Differences in Process of Care and Mortality?" Journal of Healthcare Management 54, no. 1 (Jan/Feb

Jiang, Z., L. Yang, P. Guo, and S. Gong. "Autonomy and Authority in Medical Futility." J Biomed Res 28, no. 6 (Nov 2014): 433-4.

Jiang, Z., L. Yang, P. Guo, and S. Gong. "Medical Futility in the Era of Evidence-Based Medicine." J Biomed Res 28, no. 4 (Jul 2014): 249-50.

Joffe, Steven, and Jennifer W. Mack. "Deliberation and the Life Cycle of Informed Consent." Hastings Center Report 44, no. 1 (2018-01-13 2014): 33-35.

Jones, D. Scott. "Reporting Adverse Medical Events: Quality Reporting Meets Compliance." Journal of Health Care Compliance 14, no. 4 (2012): 53-76.

Jones, David S. M. D. PhD, Scott H. M. D. Podolsky, and Jeremy A. M. D. PhD Greene. "The Burden of Disease and the Changing Task of Medicine." The New England Journal of Medicine 366, no. 25 (2012): 2333-8.

Jonsen, Albert R., Marc Siegler, and William J. Winslade. 2015 (8th edition). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. New York: McGraw Hill Education.

Joseph, R. "Hospital Policy on Medical Futility - Does It Help in Conflict Resolution and Ensuring Good End-of-Life Care?" Ann Acad Med Singapore 40, no. 1 (Jan 2011): 19-25.

Juckett, G. "Cross-Cultural Medicine." Am Fam Physician 72, no. 11 (2005): 2267-74.

Jukic, M., L. Saric, I. Prkic, and L. Puljak. "Medical Futility Treatment in Intensive Care Units." Acta Med Acad 45, no. 2 (Nov 2016): 135-44.

Page 317: An Ethical Framework for Organizational Resource

 

309

Jurkiewicz, Carole L., and Carolyn R. Thompson. "Conflict of Interest: Organizational Vs. Executive Ethics in Health Care." Journal of Health and Human Services Administration 23, no. 1 (2000): 100-23.

Kachalia, Allen M. D. J. D. "Improving Patient Safety through Transparency." The New England Journal of Medicine 369, no. 18 (2013): 1677-9.

Kane, P. M., F. E. Murtagh, K. Ryan, N. G. Mahon, B. McAdam, R. McQuillan, C. Ellis-smith, et al. "The Gap between Policy and Practice: A Systematic Review of Patient-Centered Care Interventions in Chronic Heart Failure." Heart Failure Reviews 20, no. 6 (Nov 2015): 673-87.

Kapiriri, L., and D. Razavi. "How Have Systematic Priority Setting Approaches Influenced Policy Making? A Synthesis of the Current Literature." Health Policy 121, no. 9 (Sep 2017): 937-46.

Kaplan, Heather C., Patrick W. Brady, Michele C. Dritz, David K. Hooper, W. Matthew Linam, Craig M. Froehle, and Peter Margolis. "The Influence of Context on Quality Improvement Success in Health Care: A Systematic Review of the Literature”

Kaufman, Arnold S. "Responsibility, Moral and Legal." In Encyclopedia of Philosophy, edited by Donald M. Borchert, 444-51. Detroit: Macmillan Reference USA, 2006.

Keegan, Theresa H. M., Allison W. Kurian, Kathleen Gali, Tao Li, Daphne Y. Lichtensztajn, Dawn L. Hershman, Laurel A. Habel, Bette J. Caan, and Scarlett L. Gomez. "Research and Practice. Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival among Women in an Integrated Health System." American Journal of Public Health 105, no. 5 (2015): 938-46.

Keegan, Theresa H. M., Allison W. Kurian, Kathleen Gali, Tao Li, Daphne Y. Lichtensztajn, Dawn L. Hershman, Laurel A. Habel, Bette J. Caan, and Scarlett L. Gomez. "Research and Practice. Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival among Women in an Integrated Health System." American Journal of Public Health 105, no. 5 (2015): 938-46.

Kekewich, M., J. Landry, and V. Roth. "How Should Health Leaders Approach Morally Contentious Policy Issues?" Healthc Manage Forum 31, no. 1 (Jan 2018): 29-31.

Kelleher, J. Paul. "Beneficence, Justice, and Health Care." Kennedy Institute of Ethics Journal 24, no. 1 (Mar 2014 2014-08-12 2014): 27-49.

Kelley, Michele A. "Cultural Competency." In Encyclopedia of Health Services Research, edited by Ross M. Mullner, 270-274. Thousand Oaks, CA: SAGE Publications, Inc., 2009. doi: 10.4135/9781412971942.n98.

Kennedy, Denise M. M. B. A., Richard J. M. D. Caselli, Leonard L. PhD Berry, and Pooja Fache Mishra. "A Roadmap for Improving Healthcare Service Quality/Practitioner

Page 318: An Ethical Framework for Organizational Resource

 

310

Application." Journal of Healthcare Management 56, no. 6 (Nov/Dec 2011): 385-400; discussion 00-2.

Kerby, Rob. "Welfare and Poverty." In Encyclopedia of Politics, edited by Rodney P. Carlisle. The Left, 489-91. Thousand Oaks, CA: SAGE Reference, 2005.

Khorakian, Alireza, Yaghoob Maharati, and Hanzaleh Zeydvand Lorestany. "Virtuousness and Effectiveness in Hospitals: The Moderating Role of Organizational Culture." Advances in Management and Applied Economics 6, no. 4 (2016): 45-66.

Khushf, George, James Raymond, and Charles Beaman. "The Institute of Medicine's Reports on Quality and Safety: Paradoxes and Tensions." HEC Forum 20, no. 1 (2008): 1-14.

Kieslich, Katharina, and Peter Littlejohns. "Does Accountability for Reasonableness Work? A Protocol for a Mixed Methods Study Using an Audit Tool to Evaluate the Decision-Making of Clinical Commissioning Groups in England." BMJ Open 5, no. 7 (2015).

Kilner, John F. "Healthcare Resources, Allocation Of: I. Macroallocation." In Encyclopedia of Bioethics, edited by Stephen G. Post, 1098-107. New York: Macmillan Reference USA, 2004.

Kilpatrick, Shelley Dean. "Helping Behavior." In Encyclopedia of Social Psychology, edited by Roy F. Baumeister and Kathleen D. Vohs, 420-24. Thousand Oaks, CA: SAGE Publications, 2007.

Kim, Linda, Courtney H. Lyder, Donna McNeese-Smith, Linda Searle Leach, and Jack Needleman. "Defining Attributes of Patient Safety through a Concept Analysis." Journal of Advanced Nursing 71, no. 11 (2015): 2490-503.

Kinnear, John, and Ruth Jackson. "Constructing Diagnostic Likelihood: Clinical Decisions Using Subjective Versus Statistical Probability." Postgraduate Medical Journal 93, no. 1101 (Jul 2017): 425.

Kinney, Eleanor D. "Realization of the International Human Right to Health in an Economically Integrated North America." The Journal of Law, Medicine & Ethics 37, no. 4 (2009): 807-818.

Knight, Carl, and Andreas Albertsen. "Rawlsian Justice and Palliative Care." Bioethics 29, no. 8 (Oct 2015): 536-42.

Ko, Michelle, Julia Murphy, and Andrew B. Bindman. "Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures between Us Hospitals and Community Health Centers." American Journal of Public Health 105, no. S5 (2015): S676-S79.

Kocarnik, Jonathan M. "Disclosing Controversial Risk in Informed Consent: How Serious Is Serious?" American Journal of Bioethics 14, no. 4 (2014): 13-14.

Page 319: An Ethical Framework for Organizational Resource

 

311

Kopolow, Andrew M., and Louis E. Kopolow. "Corporate Social Responsibility in Health." In Bioethics, edited by Bruce Jennings, 715-18. Farmington Hills, MI: Macmillan Reference USA, 2014.

Krehbiel, Patricia J., and Russell Cropanzano. "Procedural Justice, Outcome Favorability and Emotion." Social Justice Research 13, no. 4 (December 2000): 339-60.

Krieger, N. "Health Equity and the Fallacy of Treating Causes of Population Health as If They Sum to 100." Am J Public Health 107, no. 4 (Apr 2017): 541-49.

Kronenfeld, Jennie, Wendy Parmet, and Mark Zezza. "Debates on U.S. Health Care: Health Care as a Human Right." Thousand Oaks, California: SAGE Publications, Inc., 2012.

Kte'pi, Bill. "Equity and Equality." In Multicultural America: A Multimedia Encyclopedia, edited by Carlos E. Cortés Thousand Oaks, California: SAGE Publications, Inc., 2013.

Kulkarni, K., S. J. Karssiens, H. Massie, and H. Pandit. "Smoking and Orthopaedic Surgery: Does the Evidence Support Rationing of Care?" Musculoskeletal Care 15, no. 4 (Dec 2017): 400-04.

Kvist, Tarja, Ari Voutilainen, Raija Mäntynen, and Katri Vehviläinen-Julkunen. "The Relationship between Patients' Perceptions of Care Quality and Three Factors: Nursing Staff Job Satisfaction, Organizational Characteristics and Patient”

Ladin, Keren PhD, and Douglas W. Hanto. "Rationing Lung Transplants -- Procedural Fairness in Allocation and Appeals." The New England Journal of Medicine 369, no. 7 (2013): 599-601.

Lakes, Kimberley D., Elaine Vaughan, Marissa Jones, Wylie Burke, Dean Baker, and James M. Swanson. "Diverse Perceptions of the Informed Consent Process: Implications for the Recruitment and Participation of Diverse Communities in the National Children's Study." American Journal of Community Psychology 49, no. 1-2 (Mar 2012): 215-32.

Landwehr, C., and D. Klinnert. "Value Congruence in Health Care Priority Setting: Social Values, Institutions and Decisions in Three Countries." Health Econ Policy Law 10, no. 2 (Apr 2015): 113-32.

Lane, Haylee, Mitchell Sarkies, Jennifer Martin, and Terry Haines. "Equity in Healthcare Resource Allocation Decision Making: A Systematic Review." Social Science & Medicine 175 (Feb 2017): 11.

Latham, Stephen R. "Justice and the Financing of Health Care." In The Blackwell Guide to Medical Ethics, 341-53: Blackwell Publishing Ltd, 2008.

LaVeist, T. A., D. Gaskin, and P. Richard. "The Economic Burden of Health Inequalities in the United States." 2009.

Page 320: An Ethical Framework for Organizational Resource

 

312

Lawrence, David, Lauren Weigel, Paul Dale, Betsy Drph Smith, and Michael Honaker. "Presenting Stage in Colon Cancer Is Associated with Insurance Status." The American Surgeon 83, no. 7 (Jul 2017): 728-32.

Légaré, France, and Holly O. Witteman. "Shared Decision Making: Examining Key Elements and Barriers to Adoption into Routine Clinical Practice." Health Affairs 32, no. 2 (Feb 2013): 276-84.

Leicht, Karl-heinz, Wilfried Honekamp, and Herwig Ostermann. "Quality Management in Professional Medical Practices: Are There Effects on Patient Satisfaction?" Journal of Public Health 21, no. 5 (Oct 2013): 465-71.

Lemmens, Trudo, and Candice Telfer. "Access to Information and the Right to Health: The Human Rights Case for Clinical Trials Transparency." American Journal of Law and Medicine 38, no. 1 (2014-03-06 2012): 63-112.

Leppin, Aaron L., Marleen Kunneman, Julie Hathaway, Cara Fernandez, Victor M. Montori, and Jon C. Tilburt. "Getting on the Same Page: Communication, Patient Involvement and Shared Understanding of "Decisions" in Oncology." Health Expectations 21, no. 1 (Feb 2018): 110-17.

Levine, Deborah J., and Jessica Mulligan. "Overutilization, Overutilized." Journal of Health Politics, Policy & Law 40, no. 2 (2015): 421-37.

Levine, Mark A., Matthew K. Wynia, Paul M. Schyve, J. Russell Teagarden, David A. Fleming, Donohue Sharon King, J. Anderson Ron, James Sabin, and Ezekiel J. Emanuel. "Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform." The Hastings Center Report 37, no. 5 (2007): 14-19.

Lewis, Geraint, Heather Kirkham, Ian Duncan, and Rhema Vaithianathan. "How Health Systems Could Avert 'Triple Fail' Events That Are Harmful, Are Costly, and Result in Poor Patient Satisfaction." Health Affairs 32, no. 4 (Apr 2013):

Lewis, J. A., M. G. Williams, E. J. Peppers, and C. A. Gadson. "Applying Intersectionality to Explore the Relations between Gendered Racism and Health among Black Women." J Couns Psychol 64, no. 5 (Oct 2017): 475-86.

Liang, Y. H., C. H. Wei, W. H. Hsu, Y. Y. Shao, Y. C. Lin, P. C. Chou, A. L. Cheng, and K. H. Yeh. "Do-Not-Resuscitate Consent Signed by Patients Indicates a More Favorable Quality of End-of-Life Care for Patients with Advanced Cancer." Support Care Cancer 25, no. 2 (Feb 2017): 533-39.

Lie, D. A., E. Lee-Rey, A. Gomez, S. Bereknyei, and C. H. Braddock, 3rd. "Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research." J Gen Intern Med 26, no. 3 (2011): 317-25.

Page 321: An Ethical Framework for Organizational Resource

 

313

Like, Robert C. "Educating Clinicians About Cultural Competence and Disparities in Health and Health Care." Journal of Continuing Education in the Health Professions 31, no. 3 (2011): 196-206.

Liu, Tsai-Ling, A. SidneyBarritt Iv, Morris Weinberger, John E. Paul, Bruce Fried, and Justin G. Trogdon. "Who Treats Patients with Diabetes and Compensated Cirrhosis." PLoS One 11, no. 10 (Oct 2016).

Lo, Bernard. Resolving ethical dilemmas: a guide for clinicians: Lippincott Williams & Wilkins. 2013.

Lofgren, Richard, Michael Karpf, Jay Perman, and Courtney M Higdon. "The Us Health Care System Is in Crisis: Implications for Academic Medical Centers and Their Missions." Academic Medicine 81, no. 8 (2006): 713-20.

Lyell, David, Farah Magrabi, Magdalena Z. Raban, L. G. Pont, Melissa T. Baysari, Richard O. Day, and Enrico Coiera. "Automation Bias in Electronic Prescribing." BMC Medical Informatics and Decision Making 17 (2017).

Lynch, HF. Conflicts of Conscience in Health Care. An Institutional Compromise. MIT Press, 2008.

Lynch, John, Smith George Davey, Marianne Hillemeier, Mary Shaw, and et al. "Income Inequality, the Psychosocial Environment, and Health: Comparisons of Wealthy Nations." The Lancet 358, no. 9277 (2001): 194-200.

Lynn, Joanne, Mary Ann Baily, Melissa Bottrell, Bruce Jennings, Robert J. Levine, Frank Davidoff, David Casarett, et al. "The Ethics of Using Quality Improvement Methods in Health Care." Annals of Internal Medicine 146, no. 9 (2007): 666-W161.

Maak, Thomas. "Undivided Corporate Responsibility: Towards a Theory of Corporate Integrity." Journal of Business Ethics 82, no. 2 (Oct 2008): 353-68.

Madsen, Richard. "Individualism." In Encyclopedia of Community, edited by Karen Christensen and David Levinson, 648-51. Thousand Oaks, CA: SAGE Reference, 2003.

Magelssen, M., I. Miljeteig, R. Pedersen, and R. Forde. "Roles and Responsibilities of Clinical Ethics Committees in Priority Setting." BMC Med Ethics 18, no. 1 (Dec 1 2017): 68.

Maier-Lorentz, M. M. "Transcultural Nursing: Its Importance in Nursing Practice." J Cult Divers 15, no. 1 (2008): 37-43.

Malaiyandi, D. P., G. V. Henderson, and M. A. Rubin. "Transfusion of Blood Products in the Neurocritical Care Unit: An Exploration of Rationing and Futility." Neurocrit Care (Dec 29 2017).

Mant, Jonathan. "Process Versus Outcome Indicators in the Assessment of Quality of Health Care." International Journal for Quality in Health Care 13, no. 6 (2001): 475.

Page 322: An Ethical Framework for Organizational Resource

 

314

Mantel, Jessica. "Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethics." Journal of Law, Medicine & Ethics 43, no. 3 (Fall 2015): 661-65.

Marckmann, G., and J. In der Schmitten. "Financial Toxicity of Cancer Drugs: Possible Remedies from an Ethical Perspective." Breast Care (Basel) 12, no. 2 (May 2017): 81-85.

Marcum, James A. "Clinical Decision-Making, Gender Bias, Virtue Epistemology, and Quality Healthcare." Topoi: An International Review of Philosophy 36, no. 3 (2017-12-19 2017): 501-08.

Marcus, Brian S., Gary Shank, Jestin N. Carlson, and Arvind Venkat. "Qualitative Analysis of Healthcare Professionals' Viewpoints on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas." HEC Forum 27, no. 1 (March 2015): 11-34.

Margenthaler, Julie A., and David Facs Ollila. "Breast Conservation Therapy Versus Mastectomy: Shared Decision-Making Strategies and Overcoming Decisional Conflicts in Your Patients." Annals of Surgical Oncology 23, no. 10 (Oct 2016): 3133-37.

Margolis, B., L. Chen, M. K. Accordino, G. Clarke Hillyer, J. Y. Hou, A. I. Tergas, W. M. Burke, et al. "Trends in End-of-Life Care and Health Care Spending in Women with Uterine Cancer." Am J Obstet Gynecol 217, no. 4 (Oct 2017): 434.e1-34.e10.

Marmot, Michael. "Achieving Health Equity: From Root Causes to Fair Outcomes." The Lancet 370, no. 9593 (2007): 1153-63.

Martin, Angela K., Nicolas Tavaglione, and Samia Hurst. "Resolving the Conflict: Clarifying 'Vulnerability' in Health Care Ethics." Kennedy Institute of Ethics Journal 24, no. 1 (Mar 2014): 51-72.

Martin, L. J., M. H. Roper, L. Grandjean, R. H. Gilman, J. Coronel, L. Caviedes, J. S. Friedland, and D. A. Moore. "Rationing Tests for Drug-Resistant Tuberculosis - Who Are We Prepared to Miss?" BMC Med 14 (Mar 23 2016): 30.

Massetti, G. M., C. C. Thomas, and K. R. Ragan. "Disparities in the Context of Opportunities for Cancer Prevention in Early Life." Pediatrics 138, no. Suppl 1 (Nov 2016): S65-S77.

Mattarozzi, Katia, Valentina Colonnello, Francesco De Gioia, and Alexander Todorov. "I Care, Even after the First Impression: Facial Appearance-Based Evaluations in Healthcare Context." Social Science & Medicine 182 (Jun 2017): 68.

Matthew Lee, Smith, Thomas R. Prohaska, Kara E. MacLeod, Marcia G. Ory, Amy R. Eisenstein, David R. Ragland, Cheryl Irmiter, Samuel D. Towne, and William A. Satariano. "Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA." International Journal of Environmental Research and Public Health 14, no. 2 (2017): 174.

Page 323: An Ethical Framework for Organizational Resource

 

315

Mbugua, K. "Respect for Cultural Diversity and the Empirical Turn in Bioethics: A Plea for Caution." J Med Ethics Hist Med 5 (2012): 1.

McAlearney, Ann Scheck ScD, and Peter W. Butler. "Using Leadership Development Programs to Improve Quality and Efficiency in Healthcare." Journal of Healthcare Management 53, no. 5 (Sep/Oct 2008): 319-31; discussion 31-2.

McCormack, Richard, Ryan Michels, Nicholas Ramos, Lorraine Hutzler, James Slover, Joseph Bosco, and Arby Facs Khan. "Thirty-Day Readmission Rates as a Measure of Quality: Causes of Readmission after Or”

McCullough, Laurence B. "Practicing Preventive Ethics--the Keys to Avoiding Ethical Conflicts in Health Care." Physician Executive 31, no. 2 (2005): 18-21.

McDonald, Robert, E. "An Investigation of Innovation in Nonprofit Organizations: The Role of Organizational Mission." Nonprofit & Voluntary Sector Quarterly 36, no. 2 (2007): 256-81.

McQuoid-Mason, D. J. "Should Doctors Provide Futile Medical Treatment If Patients or Their Proxies Are Prepared to Pay for It?" S Afr Med J 107, no. 2 (Jan 30 2017): 108-09.

Mechanic, David, and Jennifer Tanner. "Vulnerable People, Groups, and Populations: Societal View." Health Affairs 26, no. 5 (2007): 1220-30.

Meier, B. M., and W. Onzivu. "The Evolution of Human Rights in World Health Organization Policy and the Future of Human Rights through Global Health Governance." Public Health 128, no. 2 (Feb 2014): 179-87.

Mein Goh, Jie, Guodong Gao, and Ritu Agarwal. "The Creation of Social Value: Can an Online Health Community Reduce Rural–Urban Health Disparities?" MIS Quarterly 40, no. 1 (2016): 247-63.

Meltzer, David O., and Jeanette W. Chung. "The Population Value of Quality Indicator Reporting: A Framework for Prioritizing Health Care Performance Measures." Health Affairs 33, no. 1 (Jan 2014): 132-9.

Mena, Sébastien, Marieke de Leede, Dorothée Baumann, Nicky Black, Sara Lindeman, and Lindsay McShane. "Advancing the Business and Human Rights Agenda: Dialogue, Empowerment, and Constructive Engagement." Journal of Business Ethics 93, no. 1 (Apr 2010): 161-88.

Mende, Susan, and Deborah Roseman. "The Aligning Forces for Quality Experience: Lessons on Getting Consumers Involved in Health Care Improvements." Health Affairs 32, no. 6 (Jun 2013): 1092-100.

Menzel, Paul T. "Setting Priorities for a Basic Minimum of Accessible Health Care." In Medicine and Social Justice: Essays on the Distribution of Health Care, Second ed. New York: Oxford University Press, 2012. 131-141.

Page 324: An Ethical Framework for Organizational Resource

 

316

Meyerson, Denise. "Innovative Surgery and the Precautionary Principle." Journal of Medicine and Philosophy 38, no. 6 (2013): 605-24.

Millar, Ross. "Framing Quality Improvement Tools and Techniques in Healthcare." Journal of Health Organization and Management 27, no. 2 (2013): 209-24.

Misak, C. J., D. B. White, and R. D. Truog. "Medically Inappropriate or Futile Treatment: Deliberation and Justification." J Med Philos 41, no. 1 (Feb 2016): 90-114.

Mitchell, Melanie A. "Assessing Patient Decision-Making Capacity: It's About the Thought Process." Journal of Emergency Nursing 41, no. 4 (Jul 2015): 307-12.

Mitton, Craig, Francois Dionne, and Cam Donaldson. "Managing Healthcare Budgets in Times of Austerity: The Role of Program Budgeting and Marginal Analysis." Applied Health Economics and Health Policy 12, no. 2 (Apr 2014): 95-102.

Mohammed, Shan, and Elizabeth Peter. "Rituals, Death and the Moral Practice of Medical Futility." Nursing Ethics 16, no. 3 (May 2009): 292-302.

Mohindra, R. K. "Medical Futility: A Conceptual Model." J Med Ethics 33, no. 2 (Feb 2007): 71-5.

Molina, Kristine, and Yenisleidy Simon. "Everyday Discrimination and Chronic Health Conditions among Latinos: The Moderating Role of Socioeconomic Position." Journal of Behavioral Medicine 37, no. 5 (2014): 868-80 13p.

Molina, Kristine, and Yenisleidy Simon. "Everyday Discrimination and Chronic Health Conditions among Latinos: The Moderating Role of Socioeconomic Position." Journal of Behavioral Medicine 37, no. 5 (2014): 868-80 13p.

Moosa, Mohammed Rafique, Jonathan David Maree, Maxwell T. Chirehwa, and Solomon R. Benatar. "Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country." PLoS One 11, no. 10 (Oct 2016).

Morata, L. "An Evolutionary Concept Analysis of Futility in Health Care." J Adv Nurs (Jan 19 2018).

Moye, Jennifer, Casey Catlin, Jennifer Kwak, Erica Wood, and Pamela B. Teaster. "Ethical Concerns and Procedural Pathways for Patients Who Are Incapacitated and Alone: Implications from a Qualitative Study for Advancing Ethical Practice." HEC Forum 29, no. 2 (Jun 2017): 171-89.

Mt, Joannathan. "Process Versus Outcome Indicators in the Assessment of Quality of Health Care." International Journal for Quality in Health Care 13, no. 6 (2001): 475.

Murphy, Matthew, and Jordi Vives. "Perceptions of Justice and the Human Rights Protect, Respect, and Remedy Framework." Journal of Business Ethics 116, no. 4 (Sep 2013): 781-97.

Page 325: An Ethical Framework for Organizational Resource

 

317

Myers, J. "Measuring Quality of End-of-Life Communication and Decision-Making: Do We Have This Right?" Cmaj 189, no. 30 (Jul 31 2017): E978-e79.

Naidu, Aditi. "Factors Affecting Patient Satisfaction and Healthcare Quality." International Journal of Health Care Quality Assurance 22, no. 4 (2009): 366-81.

Narayan, Mary Curry. "Six Steps toward Cultural Competence: A Clinician’s Guide." Home Health Care Management & Practice 14, no. 1 (2001): 40-48.

Nates, J. L., M. Nunnally, R. Kleinpell, S. Blosser, J. Goldner, B. Birriel, C. S. Fowler, et al. "Icu Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research." Crit Care Med 44, no. 8 (Aug 2016): 1553-602.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Bethesda, Md.: The Commission, 1978.

National Quality Forum. “Serious Reportable Events.” 2008.http://www.qualityforum.org/topics/sres/serious_reportable_events.aspx

Ndumbe-eyoh, Sume, and Agnes Mazzucco. "Social Media, Knowledge Translation, and Action on the Social Determinants of Health and Health Equity: A Survey of Public Health Practices." Journal of Public Health Policy 37 (Nov 2016): 249-59.

Nedjat-Haiem, F. R., I. V. Carrion, K. Gonzalez, K. Ell, B. Thompson, and S. I. Mishra. "Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication." Am J Hosp Palliat Care 34, no. 4 (May 2017): 308-17.

Nelson, C. M., and B. A. Nazareth. "Nonbeneficial Treatment and Conflict Resolution: Building Consensus." Perm J 17, no. 3 (Summer 2013): 23-7.

Nelson, W. A. "The Ethics of Avoiding Nonbeneficial Healthcare: Unnecessary Treatment Has Both Financial and Moral Implications." Healthc Exec 27, no. 6 (Nov-Dec 2012): 48, 50-1.

Nelson, William A., Julia Neily, Peter Mills, and William B. Weeks. "Collaboration of Ethics and Patient Safety Programs: Opportunities to Promote Quality Care." HEC Forum 20, no. 1 (2008): 15-27.

Nelson, William A., William B. Weeks, Justin M. Campfield, and Les MacLeod. "The Organizational Costs of Ethical Conflicts." Journal of Healthcare Management 53, no. 1 (Jan/Feb 2008): 41-52; discussion 52-3.

Neville, T. H., A. Ziman, and N. S. Wenger. "Blood Products Provided to Patients Receiving Futile Critical Care." J Hosp Med 12, no. 9 (Sep 2017): 739-42.

Page 326: An Ethical Framework for Organizational Resource

 

318

Neville, T. H., J. F. Wiley, E. S. Holmboe, C. H. Tseng, P. Vespa, E. C. Kleerup, and N. S. Wenger. "Differences between Attendings' and Fellows' Perceptions of Futile Treatment in the Intensive Care Unit at One Academic Health Center: Implications for Training." Acad Med 90, no. 3 (Mar 2015): 324-30.

Nix, Kathryn A., and John S. O'Shea. "Improving Healthcare Quality in the United States: A New Approach." Southern Medical Journal 108, no. 6 (2015): 359-63.

Nordhaug, M., and P. Nortvedt. "Justice and Proximity: Problems for an Ethics of Care." Health Care Anal 19, no. 1 (Mar 2011): 3-14.

Norheim, O. F., R. Baltussen, M. Johri, D. Chisholm, E. Nord, D. Brock, P. Carlsson, et al. "Guidance on Priority Setting in Health Care (Gps-Health): The Inclusion of Equity Criteria Not Captured by Cost-Effectiveness Analysis." Cost Eff Resour Alloc 12 (2014): 18.

Nunes, R., and G. Rego. "Priority Setting in Health Care: A Complementary Approach." Health Care Anal 22, no. 3 (Sep 2014): 292-303.

Oczkowski, S. "Antimicrobial Stewardship Programmes: Bedside Rationing by Another Name?" J Med Ethics 43, no. 10 (Oct 2017): 684-87.

Odekon, Mehmet. " Equity in Health” The Sage Encyclopedia of World Poverty Thousand Oaks, California: SAGE Publications, Inc, 2015.

Odekon, Mehmet. "Equity and Efficiency Tradeoff." In The SAGE Encyclopedia of World Poverty Thousand Oaks

Oei, Grace. "Explicit Versus Implicit Rationing: Let's Be Honest." American Journal of Bioethics 16, no. 7 (2018-01-13 2016): 68-70.

Office of the High Commissioner, United Nations. Guiding Principles on Business and Human Rights: Implementing the United Nations "Protect, Respect and Remedy" Framework. New York and Geneva: United Nations, 2011.

Ohr, S., S. Jeong, and P. Saul. "Cultural and Religious Beliefs and Values, and Their Impact on Preferences for End-of-Life Care among Four Ethnic Groups of Community-Dwelling Older Persons." J Clin Nurs 26, no. 11-12 (Jun 2017): 1681-89.

Oliver, A., and E. Mossialos. "Equity of Access to Health Care: Outlining the Foundations for Action." J Epidemiol Community Health 58, no. 8 (Aug 2004): 655-8.

Olmstead, J. A., and M. D. Dahnke. "The Need for an Effective Process to Resolve Conflicts over Medical Futility: A Case Study and Analysis." Crit Care Nurse 36, no. 6 (Dec 2016): 13-23.

Page 327: An Ethical Framework for Organizational Resource

 

319

Olson, Maren E, Douglas Diekema, Barbara A Elliott, and Colleen M Renier. "Impact of Income and Income Inequality on Infant Health Outcomes in the United States." Pediatrics 126, no. 6 (2010): 1165-73.

Olthuis, Gert, Carlo Leget, and Mieke Grypdonck. "Why Shared Decision Making Is Not Good Enough: Lessons from Patients." Journal of Medical Ethics 40, no. 7 (Jul 2014): 493.

Oshima Lee, Emily M. A., and Ezekiel J. M. D. PhD Emanuel. "Shared Decision Making to Improve Care and Reduce Costs." The New England Journal of Medicine 368, no. 1 (2013 Jan 03): 6-8.

Osuji, Onyeka K., and Ugochukwu L. Obibuaku. "Rights and Corporate Social Responsibility: Competing or Complementary Approaches to Poverty Reduction and Socioeconomic Rights?" Journal of Business Ethics 136, no. 2 (Jun 2016): 329-47.

Otani, Koichiro, Brian Waterman, Kelly M. Faulkner, Sarah Boslaugh, W. Claiborne Dunagan, and Sue PhD Ehinger. "How Patient Reactions to Hospital Care Attributes Affect the Evaluation of Overall Quality of Care, Willingness to Recommend, and Willingness to Return/Practitioner Application." Journal of Healthcare Management 55, no. 1 (Jan/Feb 2010): 25-37; discussion 38.

Ottersen, T. "Lifetime Qaly Prioritarianism in Priority Setting." J Med Ethics 39, no. 3 (Mar 2013): 175-80.

Ottersen, T., O. Maestad, and O. F. Norheim. "Lifetime Qaly Prioritarianism in Priority Setting: Quantification of the Inherent Trade-Off." Cost Eff Resour Alloc 12, no. 1 (Jan 14 2014): 2.

Owen-Smith, A., J. Donovan, and J. Coast. "How Clinical Rationing Works in Practice: A Case Study of Morbid Obesity Surgery." Soc Sci Med 147 (Dec 2015): 288-95.

Ozar, David T. "Profession and Professional Ethics." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2158-69. New York: Macmillan Reference USA, 2004.

Özden, Dilek, Serife Karagözolu, and Gülay Yildirim. "Intensive Care Nurses' Perception of Futility: Job Satisfaction and Burnout Dimensions." Nursing Ethics 20, no. 4 (Jun 2013): 436-47.

Padgett, Jared, Kenneth Gossett, Roger Mayer, Wen-Wen Chien, and Freda Turner. "Improving Patient Safety through High Reliability Organizations." The Qualitative Report 22, no. 2 (Feb 2017): 410-25.

Parast, Layla, Brian Doyle, Cheryl L. Damberg, Kanaka Shetty, David A. Ganz, Neil S. Wenger, and Paul G. Shekelle. "Challenges in Assessing the Process-Outcome Link in Practice." Journal of General Internal Medicine 30, no. 3

Park, Seri, and Tamara M. Kear. "Current State-of-Practice: Transportation for Patients with End Stage Renal Disease." Nephrology Nursing Journal 44, no. 4 (Jul/Aug 2017): 309-15.

Page 328: An Ethical Framework for Organizational Resource

 

320

Partain, D. K., C. Ingram, and J. J. Strand. "Providing Appropriate End-of-Life Care to Religious and Ethnic Minorities." Mayo Clin Proc 92, no. 1 (Jan 2017): 147-52.

Pavlish, Carol Faan, Katherine Brown-Saltzman, Loretta Cgrn So, Amy Heers, and Nicole Iorillo. "Avenues of Action in Ethically Complex Situations: A Critical Incident Study." Journal of Nursing Administration 45, no. 6 (Jun 2015): 311.

Payne, G. H., S. D. James, Jr., L. Hawley, B. Corrigan, R. E. Kramer, S. N. Overton, R. P. Farris, and Y. Wasilewski. "Cdc's Health Equity Resource Toolkit: Disseminating Guidance for State Practitioners to Address Obesity Disparities." Health Promot Pract 16, no. 1 (Jan 2015): 84-90.

Peacock, S. J. "Public Attitudes and Values in Priority Setting." Isr J Health Policy Res 4 (2015): 29.

Pearson, SD et al. No Margin, No Mission. Health Care Organizations and the Quest for Ethical Excellence. Oxford University Press, 2003.

Peek, Monica E., Shannon C. Wilson, Rita Gorawara-bhat, Angela Odoms-young, Michael T. Quinn, and Marshall H. Chin. "Barriers and Facilitators to Shared Decision-Making among African-Americans with Diabetes." Journal of General Internal Medicine 24, no. 10 (Oct 2009): 1135-9.

Pega, Frank, Nicole B. Valentine, Kumanan Rasanathan, Ahmad Reza Hosseinpoor, Tone P. Torgersen, Veerabhadran Ramanathan, Tipicha Posayanonda, et al. "The Need to Monitor Actions on the Social Determinants of Health." World Health Organization. Bulletin of the World Health Organization 95, no. 11 (Nov 2017): 784-87.

Peppercorn, Jeffrey, S. Yousuf Zafar, Kevin Houck, Peter Ubel, and Neal J. Meropol. "Does Comparative Effectiveness Research Promote Rationing of Cancer Care?" Lancet Oncology 15, no. 3 (Mar 2014): e132-8.

Periyakoil, Vyjeyanthi S., Eric Neri, and Helena Kraemer. "No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients." PLoS One 10, no. 4 (Apr 2015).

Perkins, Henry S. "Culture as a Useful Conceptual Tool in Clinical Ethics Consultation." Cambridge Quarterly of Healthcare Ethics 17, no. 2 (Apr 2008): 164-72.

Peroni, Lourdes, and Alexandra Timmer. "Vulnerable Groups: The Promise of an Emerging Concept in European Human Rights Convention Law." International Journal of Constitutional Law 11, no. 4 (October 2013): 1056-85.

Phibbs, Sandi Cleveland, Jennifer Faith, and Sheryl Thorburn. "Patient-Centred Communication and Provider Avoidance: Does Body Mass Index Modify the Relationship?" The Health Education Journal 76, no. 1 (Feb 2017): 120-27.

Page 329: An Ethical Framework for Organizational Resource

 

321

Pinto, Andrew D. and Upshur, Ross E.G. (eds.): An introduction to global health ethics. Routledge, London and New York, 2013. 48-49.

Post, SG. "Clinical Ethics." Encyclopedia of Bioethics. New York: Macmillan Reference USA, 2004.

Potvin, Louise. "Promoting Health and Equity: A Theme That Is More Relevant Than Ever." Global Health Promotion 22, no. 1 (2015): 3-5.

Powers, Madison. "Social Justice." In Bioethics, edited by Bruce Jennings, 2966-73. Farmington Hills, MI: Macmillan Reference USA, 2014. 2966 -2970

Pratesi, A., F. Orso, C. Ghiara, A. Lo Forte, A. C. Baroncini, M. L. Di Meo, E. Carassi, and S. Baldasseroni. "Cardiac Surgery in the Elderly: What Goals of Care?" Monaldi Arch Chest Dis 87, no. 2 (Jul 18 2017): 852.

Price, Bob. "Discussing Risk with Patients." Nursing Standard (2014+) 31, no. 33 (2017): 53.

Pritchard-Jones, L. "Ageism and Autonomy in Health Care: Explorations through a Relational Lens." Health Care Anal 25, no. 1 (Mar 2017): 72-89.

Pronovost, Peter J., and Jill A. Marsteller. "Creating a Fractal-Based Quality Management Infrastructure." Journal of Health Organization and Management 28, no. 4 (2014): 576-86.

Pronovost, Peter J., Thomas Nolan, Scott Zeger, Marlene Miller, and Haya Rubin. "How Can Clinicians Measure Safety and Quality in Acute Care?" The Lancet 363, no. 9414 (2004): 1061-7.

Puras, Dainius. "Human Rights and the Practice of Medicine." (2017): Public Health Reviews 38.

Purtilo, Ruth B. "Professional–Patient Relationship: Iii. Ethical Issues." In Encyclopedia of Bioethics, edited by Stephen G. Post, 2150-58. New York: Macmillan Reference USA, 2004.

Qato, Dima Mazen, Shannon Zenk, Jocelyn Wilder, Rachel Harrington, Darrell Gaskin, and G. Caleb Alexander. "The Availability of Pharmacies in the United States: 2007-2015." PLoS One 12, no. 8 (Aug 2017).

Ram-tiktin, Efrat. "The Right to Health Care as a Right to Basic Human Functional Capabilities." Ethical Theory and Moral Practice 15, no. 3 (Jun 2012): 337-51.

Ratcliffe, J., E. Lancsar, R. Walker, and Y. Gu. "Understanding What Matters: An Exploratory Study to Investigate the Views of the General Public for Priority Setting Criteria in Health Care." Health Policy 121, no. 6 (Jun 2017): 653-62.

Page 330: An Ethical Framework for Organizational Resource

 

322

Reed, Peter, Douglas A. Conrad, Susan E. Hernandez, Carolyn Watts, and Miriam Marcus-Smith. "Innovation in Patient-Centered Care: Lessons from a Qualitative Study of Innovative Health Care Organizations in Washington State." BMC Family Practice 13 (2012): 120.

Reese, P. P., A. L. Caplan, R. D. Bloom, P. L. Abt, and J. H. Karlawish. "How Should We Use Age to Ration Health Care? Lessons from the Case of Kidney Transplantation." J Am Geriatr Soc 58, no. 10 (Oct 2010): 1980-6.

Repenshek, Mark. "Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?" Nursing Ethics 16, no. 6 (Nov 2009): 734-42.

Rhodes, Rosamond. "The Professional Responsibilities of Medicine." In The Blackwell Guide to Medical Ethics, 71-87: Blackwell Publishing Ltd, 2008.

Rid, A. "Justice and Procedure: How Does "Accountability for Reasonableness" Result in Fair Limit-Setting Decisions?" Journal of Medical Ethics 35, no. 1 (Jan 2009): 12.

Rising, M. L. "Truth Telling as an Element of Culturally Competent Care at End of Life." J Transcult Nurs 28, no. 1 (Jan 2017): 48-55.

Robert Wachter. Understanding Patient Safety. McGraw Hill, 2007. 3-12

Robertson-Preidler, Joelle, Nikola Biller-Andorno, and Tricia J. Johnson. "What Is Appropriate Care? An Integrative Review of Emerging Themes in the Literature." BMC Health Services Research 17 (2017).

Rodwin, Marc A. Conflicts of Interest and the Future of Medicine. Oxford University Press. 2011. 8-11

Roessler, Richard T., Malachy Bishop, Phillip D. Rumrill, Kathleen Sheppard-Jones, Brittany Waletich, Veronica Umeasiegbu, and Lisa Bishop. "Specialized Housing and Transportation Needs of Adults with Multiple Sclerosis." Work 45, no. 2 (2013): 223-35.

Rogers, W. A. "Evidence Based Medicine and Justice: A Framework for Looking at the Impact of Ebm Upon Vulnerable or Disadvantaged Groups." J Med Ethics 30, no. 2 (Apr 2004): 141-5.

Rogers, W., C. Degeling, and C. Townley. "Equity under the Knife: Justice and Evidence in Surgery." Bioethics 28, no. 3 (Mar 2014): 119-26.

Rogers, Wendy A., Catriona Mackenzie, and Susan Dodds. "Vulnerability." In Bioethics, edited by Bruce Jennings, 3149-53. Farmington Hills, MI: Macmillan Reference USA, 2014.

Rogowski, Wolf H., Scott D. Grosse, Jörg Schmidtke, and Georg Marckmann. "Criteria for Fairly Allocating Scarce Health-Care Resources to Genetic Tests: Which Matter Most?" European Journal of Human Genetics : EJHG 22, no. 1 (Jan 2014): 25-31.

Page 331: An Ethical Framework for Organizational Resource

 

323

Romain, Frederic, and Andrew Courtwright. "Can I Trust Them to Do Everything? The Role of Distrust in Ethics Committee Consultations for Conflict over Life-Sustaining Treatment among Afro-Caribbean Patients." Journal of Medical Ethics: The Journal of the Institute of Medical Ethics 42, no. 9 (2018-01-13 2016): 582-85.

Romo, R. D., T. A. Allison, A. K. Smith, and M. I. Wallhagen. "Sense of Control in End-of-Life Decision-Making." J Am Geriatr Soc 65, no. 3 (Mar 2017): e70-e75.

Rosenberg, L. B., and D. Doolittle. "Learn and Live?: Understanding the Cultural Focus on Nonbeneficial Cardiopulmonary Resuscitation (Cpr) as a Response to Existential Distress About Death and Dying." Am J Bioeth 17, no. 2 (Feb 2017): 54-55.

Rosoff, Philip M. "Institutional Futility Policies Are Inherently Unfair." HEC Forum 25, no. 3 (Sep 2013): 191-209.

Rothman DJ and Rothman Sheila M. Trust is not enough. Bringing human rights to medicine. New York Review of Books, New York, 2006. 152-153

Rubin, Susan B. "If We Think It's Futile, Can't We Just Say No?" HEC Forum 19, no. 1 (Mar 2007): 45-65.

Rumbold, B., A. Weale, A. Rid, J. Wilson, and P. Littlejohns. "Public Reasoning and Health-Care Priority Setting: The Case of Nice." Kennedy Inst Ethics J 27, no. 1 (2017): 107-34.

Rumbold, B., R. Baker, O. Ferraz, S. Hawkes, C. Krubiner, P. Littlejohns, O. F. Norheim, et al. "Universal Health Coverage, Priority Setting, and the Human Right to Health." Lancet 390, no. 10095 (Aug 12 2017): 712-14.

Ruof, Mary C. "Vulnerability, Vulnerable Populations, and Policy." Kennedy Institute of Ethics Journal 14, no. 4 (2004): 411-25.

Russell, Roberta S., Dana M. Johnson, and Sheneeta W. White. "Patient Perceptions of Quality: Analyzing Patient Satisfaction Surveys." International Journal of Operations & Production Management 35, no. 8 (2015): 1158-81.

Russo, Fabrizio. "What Is the Csr's Focus in Healthcare?" Journal of Business Ethics 134, no. 2 (Mar 2016): 323-34.

Rust, G., R. S. Levine, Y. Fry-Johnson, P. Baltrus, J. Ye, and D. Mack. "Paths to Success: Optimal and Equitable Health Outcomes for All." J Health Care Poor Underserved 23, no. 2 Suppl (May 2012): 7-19.

Rust, G., S. Zhang, K. Malhotra, L. Reese, L. McRoy, P. Baltrus, L. Caplan, and R. S. Levine. "Paths to Health Equity: Local Area Variation in Progress toward Eliminating Breast Cancer Mortality Disparities, 1990-2009." Cancer 121, no. 16 (Aug 15 2015): 2765-74.

Rutman, Shira, Leslie Phillips, and Aren Sparck. "Health Care Access and Use by Urban American Indians and Alaska Natives: Findings from the National Health Interview

Page 332: An Ethical Framework for Organizational Resource

 

324

Survey (2006-09)." Journal of Health Care for the Poor and Underserved 27, no. 3 (Aug 2016): 1521-36.

Rutstein, S. E., J. T. Price, N. E. Rosenberg, S. M. Rennie, A. K. Biddle, and W. C. Miller. "Hidden Costs: The Ethics of Cost-Effectiveness Analyses for Health Interventions in Resource-Limited Settings." Glob Public Health 12, no. 10 (Oct 2017): 1269-81.

Sagrestano, Lynda M., Joy Clay, Ruthbeth Finerman, Jennifer Gooch, and Melanie Rapino. "Transportation Vulnerability as a Barrier to Service Utilization for Hiv-Positive Individuals." AIDS Care 26, no. 3 (2014): 314-19 6p.

Saha, S., M. C. Beach, and L. A. Cooper. "Patient Centeredness, Cultural Competence and Healthcare Quality." J Natl Med Assoc 100, no. 11 (2008): 1275-85.

Salloch, Sabine. "Same Same but Different: Why We Should Care About the Distinction between Professionalism and Ethics." BMC Medical Ethics 17 (2016).

Sargent-Cox, K. "Ageism: We Are Our Own Worst Enemy." Int Psychogeriatr 29, no. 1 (Jan 2017): 1-8.

Saric, L., I. Prkic, and M. Jukic. "Futile Treatment-a Review." J Bioeth Inq 14, no. 3 (Sep 2017): 329-37.

Satyamurthy, Shruthi, and Daniel Montanera. "Racial Concentration as a Determinant of Access to Health Care in Georgia." International Journal of Child Health and Human Development 9, no. 4 (2016): 3-14.

Saver, Barry G., Stephen A. Martin, Ronald N. Adler, Lucy M. Candib, Konstantinos E. Deligiannidis, Jeremy Golding, Daniel J. Mullin, Michele Roberts, and Stefan Topolski. "Care That Matters: Quality Measurement and Health Care."

Schenker, Yael, Frances Wang, Sarah Jane Selig, Rita Ng, and Alicia Fernandez. "The Impact of Language Barriers on Documentation of Informed Consent at a Hospital with on-Site Interpreter Services." Journal of General Internal Medicine 22 (Nov 2007): 294-9.

Scheunemann, Leslie P., Robert M. Arnold, and Douglas B. White. "The Facilitated Values History: Helping Surrogates Make Authentic Decisions for Incapacitated Patients with Advanced Illness." American Journal of Respiratory and Critical Care Medicine 186, no. 6 (2012): 480-6.

Schneiderman, L. J. "Defining Medical Futility and Improving Medical Care." J Bioeth Inq 8, no. 2 (Jun 2011): 123-31.

Schoenfeld, E. M., S. L. Goff, T. R. Elia, E. R. Khordipour, K. E. Poronsky, K. A. Nault, P. K. Lindenauer, and K. M. Mazor. "The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department." Acad Emerg Med 23, no. 12 (Dec 2016): 1417-27.

Page 333: An Ethical Framework for Organizational Resource

 

325

Schollgen, Ina, Oliver Huxhold, Benjamin Schuz, and Clemens Tesch-Romer. "Resources for Health: Differential Effects of Optimistic Self-Beliefs and Social Support According to Socioeconomic Status." Health Psychology. (2011): 326-35 10p.

Schoo, Adrian, Sharon Lawn, and Dean Carson. "Towards Equity and Sustainability of Rural and Remote Health Services Access: Supporting Social Capital and Integrated Organisational and Professional Development." BMC Health Services Research 16 (2016).

Schroeder, D., and E. Gefenas. "Vulnerability: Too Vague and Too Broad?" Camb Q Healthc Ethics 18, no. 2 (Apr 2009): 113-21.

Schulz, Valerie Marie , Allison M. Crombeen, Denise Marshall, Joshua Shadd, Kori A. LaDonna, and Lorelei Lingard. "Beyond Simple Planning: Existential Dimensions of Conversations with Patients at Risk of Dying from Heart Failure." Journal of Pain and Symptom Management 54, no. 5 (Nov 2017): 637.

Schwartz, Peter H. "Comparative Risk: Good or Bad Heuristic?" American Journal of Bioethics 16, no. 5 (2016): 20-22.

Schwarzkopf, D., H. Ruddel, D. O. Thomas-Ruddel, J. Felfe, B. Poidinger, C. T. Matthaus-Kramer, C. S. Hartog, and F. Bloos. "Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job among Icu Nurses and Junior and Senior Physicians." Crit Care Med 45, no. 3 (Mar 2017): e265-e73.

Schweda, M., S. Schicktanz, A. Raz, and A. Silvers. "Beyond Cultural Stereotyping: Views on End-of-Life Decision Making among Religious and Secular Persons in the USA, Germany, and Israel." BMC Med Ethics 18, no. 1 (Feb 17 2017): 13.

Seal, Robert P., Jeremy Kynaston, Glyn Elwyn, and Philip E. M. Smith. "Using an Option Grid in Shared Decision Making." Practical Neurology 14, no. 1 (Feb 2014): 54.

Sedhom, R., and D. Barile. "Discussing Goals of Care with Families Using the Four Steps." Gerontol Geriatr Med 2 (Jan-Dec 2016): 2333721416664446.

Sellman, Derek. "Towards an Understanding of Nursing as a Response to Human Vulnerability." Nursing Philosophy: An International Journal for Healthcare Professionals 6, no. 1 (2017-03-21 2005): 2-10.

Semplici, Stefano. "The Importance of ‘Social Responsibility’ in the Promotion of Health." Medicine, Health Care and Philosophy 14, no. 4 (2011): 355-63.

Severin, F., W. Hess, J. Schmidtke, A. Muhlbacher, and W. Rogowski. "Value Judgments for Priority Setting Criteria in Genetic Testing: A Discrete Choice Experiment." Health Policy 119, no. 2 (Feb 2015): 164-73.

Shadmi, Efrat. "Multimorbidity and Equity in Health." International Journal for Equity in Health 12 (2013): 59.

Page 334: An Ethical Framework for Organizational Resource

 

326

Shankel, Erin Christine, and Linda Wofford. "Symptom Management Theory as a Clinical Practice Model for Symptom Telemonitoring in Chronic Disease." Journal of Theory Construction & Testing 20, no. 1 (Spring/Summer 2016): 31-38.

Shaw, B. A., K. McGeever, E. Vasquez, N. Agahi, and S. Fors. "Socioeconomic Inequalities in Health after Age 50: Are Health Risk Behaviors to Blame Soc Sci Med 101 (Jan 2014): 52-60.

Sheeler, R. D., T. Mundell, S. A. Hurst, S. D. Goold, B. Thorsteinsdottir, J. C. Tilburt, and M. Danis. "Self-Reported Rationing Behavior among Us Physicians: A National Survey." J Gen Intern Med 31, no. 12 (Dec 2016): 1444-51.

Shemberg, Andrea. "New Global Standards for Business and Human Rights." Business Law International 13, no. 1 (Jan 2012): 27-33,1.

Shi, Leiyu, Lydie A. Lebrun-Harris, Charles Daly, Ravi Sharma, Alek Sripipatana, A. Seiji Hayashi, and Quyen Ngo-Metzger. "Reducing Disparities”

Shi, Leiyu, and Gregory D. Stevens. "Vulnerability and Unmet Health Care Needs." Journal of General Internal Medicine 20, no. 2 (Feb 2005): 148-54.

Shi, Leiyu, and Gregory D. Stevens. Vulnerable Populations in the United States. Second ed. San Francisco, CA: Jossey-Bass, 2010. 152-163

Shin, Dong Wook, Juhee Cho, Debra L. Roter, So Young Kim, Hyung Kook Yang, Keeho Park, Hyung Jin Kim, et al. "Attitudes toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists." Psycho - Oncology 26, no. 6 (Jun 2017): 770-78.

Shojania KG, Showstack J, Wachter RM. “Assessing Hospital Quality: A Review for Clinicians.” Eff Clin Pract 2001. 4:82-90.

Shore, David A., ed. The Trust Crisis in Healthcare: Causes, Consequences, and Cures. New York: Oxford University Press, 2006. Oxford Scholarship Online, 2009.

Shuman, Andrew G., Mary S. McCabe, Joseph J. Fins, and Paul T. Menzel. "It's Who You Know." The Hastings Center Report 42, no. 2 (Mar/Apr 2012): 12-13,48.

Sibbald, Shannon L., Jennifer L. Gibson, Peter A. Singer, Ross Upshur, and Douglas K. Martin. "Evaluating Resource allocation Success in Healthcare: A Pilot Study." BMC Health Services Research 10 (2010): 131.

Simon, J. R., C. Kraus, M. Rosenberg, D. H. Wang, E. P. Clayborne, and A. R. Derse. ""Futile Care"-an Emergency Medicine Approach: Ethical and Legal Considerations." Ann Emerg Med 70, no. 5 (Nov 2017): 707-13.

Sinha, Shashank S., and Michael W. Cullen. "Mentorship, Leadership, and Teamwork." Journal of the American College of Cardiology 66, no. 9 (2015): 1079-82.

Page 335: An Ethical Framework for Organizational Resource

 

327

Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The National Academies Press, 2002.

Smith, Lauren B., and Andrew Barnosky. "Web-Based Clinical Ethics Consultation: A Model for Hospital-Based Practice." Physician Executive 37, no. 6 (Nov/Dec 2011): 62-4.

Smith, Martin L., and Catherine L. Luck. "Desperately Seeking a Surrogate-for a Patient Lacking Decision-Making Capacity." Narrative Inquiry in Bioethics 4, no. 2 (Summer 2014): 161-69.

Smith, N., C. Mitton, W. Hall, S. Bryan, C. Donaldson, S. Peacock, J. L. Gibson, and B. Urquhart. "High Performance in Healthcare Priority Setting and Resource Allocation: A Literature- and Case Study-Based Framework in the Canadian Context." Soc Sci Med 162 (Aug 2016): 185-92.

Smith, Quentin W., Richard L. Street, Robert J. Volk, and Michael Fordis. "Differing Levels of Clinical Evidence: Exploring Communication Challenges in Shared Decision Making." Medical Care Research and Review 70, no. 1 suppl (February 2013): 3S-13S.

Smith, W. R., J. R. Betancourt, M. K. Wynia, J. Bussey-Jones, V. E. Stone, C. O. Phillips, A. Fernandez, E. Jacobs, and J. Bowles. "Recommendations for Teaching About Racial and Ethnic Disparities in Health and Health Care." Ann Intern Med 147, no. 9 (2007): 654-65.

Smith-Estelle, Allison, Laura Ferguson, and Sofia Gruskin. "Applying Human Rights-Based Approaches to Public Health: Lessons Learned from Maternal, Newborn and Child Health Programs." Etude de la Population Africaine 29, no. 1 (201

Soares, C. "Corporate Versus Individual Moral Responsibility." Journal of Business Ethics 46, no. 2 (Aug 2003): 43-50.

Solbakk, Jan Helge. "Vulnerability: A Futile or Useful Principle in Healthcare Ethics?" London: SAGE Publications Ltd, 2011..

Solovieva, Tatiana I., and Richard T. Walls. "Barriers to Traumatic Brain Injury Services and Supports in Rural Setting." Journal of Rehabilitation 80, no. 4 (2014): 10-18 9p.

Souba, W. W. "The 3 Essential Responsibilities: A Leadership Story." Arch Surg 145, no. 6 (Jun 2010): 540-3.

Spencer, EM et al. Organization Ethics in Health Care. Oxford University Press, 2000.

Sreenivasan, G. "Health Care and Human Rights: Against the Split Duty Gambit." Theor Med Bioeth 37, no. 4 (Aug 2016): 343-64.

Stacey, Gemma, Anne Felton, Ada Hui, Theo Stickley, Philip Houghton, Bob Diamond, Alastair Morgan, James Shutt, and Martin Willis. "Informed, Involved and Influential: Three Is of Shared Decision Making." Mental Health Practice (2014+) 19, no. 4 (Dec 2015): 31.

Page 336: An Ethical Framework for Organizational Resource

 

328

Stafinski, Tania, Devidas Menon, Christopher McCabe, and Donald J. Philippon. "To Fund or Not to Fund.” PharmacoEconomics 29, no. 9 (Sep 2011): 771-80.

Stelfox, Henry T., and Sharon E. Straus. "Measuring Quality of Care: Considering Measurement Frameworks and Needs Assessment to Guide Quality Indicator Development." Journal of Clinical Epidemiology 66, no. 12 (Dec 2013): 1320-7.

Stone, John R. "Commentary: Ethics and Medical Judgment: Whose Values? What Process?" Cambridge Quarterly of Healthcare Ethics 22, no. 4 (Oct 2013): 404-6.

Stone, John R. "Race and Healthcare Disparities: Overcoming Vulnerability." Theoretical Medicine and Bioethics: Philosophy of Medical Research and Practice 23, no. 6 (2017-03-21 2002): 499-518.

Stone, John R. "Saving and Ignoring Lives: Physicians' Obligations to Address Root Social Influences on Health--Moral Justifications and Educational Implications." Cambridge Quarterly of Healthcare Ethics 19, no. 4 (Oct 2010): 497-

Strech, D., and M. Danis. "How Can Bedside Rationing Be Justified Despite Coexisting Inefficiency? The Need for 'Benchmarks of Efficiency'." J Med Ethics 40, no. 2 (Feb 2014): 89-93.

Strech, Daniel M. D. PhD, Samia M. D. Hurst, and Marion M. D. Danis. "The Role of Ethics Committees and Ethics Consultation in Allocation Decisions: A 4-Stage Process." Medical Care 48, no. 9 (Sep 2010

Su, C. T., R. D. McMahan, B. A. Williams, R. K. Sharma, and R. L. Sudore. "Family Matters: Effects of Birth Order, Culture, and Family Dynamics on Surrogate Decision-Making." J Am Geriatr Soc 62, no. 1 (Jan 2014): 175-82.

Suchy, Kirsten. "A Lack of Standardization: The Basis for the Ethical Issues Surrounding Quality and Performance Reports." Journal of Healthcare Management 55, no. 4 (Jul/Aug 2010): 241-51.

Sue, Derald Wing. "Multidimensional Facets of Cultural Competence." The Counseling Psychologist 29, no. 6 (2001): 790-821.

Sulmasy, Daniel P. "Speaking of the Value of Life." Kennedy Institute of Ethics Journal 21, no. 2 (Jun 2011): 181-99.

Sutter, Robert, Brian Waterman, and Michael Udwin. "An Analytical Approach to Improving Physician Performance." Physician Executive 39, no. 3 (May/Jun 2013): 26-36.

Swinton, M., M. Giacomini, F. Toledo, T. Rose, T. Hand-Breckenridge, A. Boyle, A. Woods, et al. "Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit." Am J Respir Crit Care Med 195, no. 2 (Jan 15 2017): 198-204.

Page 337: An Ethical Framework for Organizational Resource

 

329

Tamirisa, N. P., J. S. Goodwin, A. Kandalam, S. K. Linder, S. Weller, S. Turrubiate, C. Silva, and T. S. Riall. "Patient and Physician Views of Shared Decision Making in Cancer." Health Expect 20, no. 6 (Dec 2017): 1248-53.

Tao, Wenjing, Janne Agerholm, and Bo Burstrom. "The Impact of Reimbursement Systems on Equity in Access and Quality of Primary Care: A Systematic Literature Review." BMC Health Services Research 16 (2016).

Tao, Yi, Kizito Henry, Qinpei Zou, and Xiaoni Zhong. "Methods for Measuring Horizontal Equity in Health Resource Allocation: A Comparative Study." Health Economics Review 4, no. 1 (Aug 2014): 1-10.

Tapper, E. B. "Consults for Conflict: The History of Ethics Consultation." Proc (Bayl Univ Med Cent) 26, no. 4 (Oct 2013): 417-22.

Tavaglione, N., A. K. Martin, N. Mezger, S. Durieux-Paillard, A. Francois, Y. Jackson, and S. A. Hurst. "Fleshing out Vulnerability." Bioethics 29, no. 2 (2015): 98-107.

Tavaglione, Nicolas, Angela K. Martin, and Nathalie Mezger. "Fleshing out Vulnerability." Bioethics 29, no. 2 (2017-03-21 2015): 98-107.

Ter Meulen, R. "Solidarity, Justice, and Recognition of the Other." Theor Med Bioeth 37, no. 6 (Dec 2016): 517-29.

Ter Meulen, Ruud. "Solidarity and Justice in Health Care: A Critical Analysis of Their Relationship." Diametros: An Online Journal of Philosophy 43 (2018-01-13 2015): 1-20.

Tervalon, Melanie, and Jann Murray-Garcia. "Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education." J Health Care Poor Underserved 9, no. 2 (1998):117-25.

Teunis, Teun, Stein Janssen, Thierry G. Guitton, David Ring, and Robert Parisien. "Do Orthopaedic Surgeons Acknowledge Uncertainty?" Clinical Orthopaedics and Related Research 474, no. 6 (Jun 2016): 1360-69.

Teunissen, G. J., M. A. Visse, and T. A. Abma. "Struggling between Strength and Vulnerability, a Patients' Counter Story." Health Care Analysis 23, no. 3 (2017-03-21 2015): 288-305.

Teutsch, Steven, and Bernd Rechel. "Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - Us and Europe." Public Health Reviews 34, no. 1 (2012): 1-10.

The Joint Commission. “2018 National Patient Safety Goals.” Retrieved 1/13/2018. https://www.jointcommission.org/standards_information/npsgs.aspx

The Joint Commission. “Facts about the National Patient Safety Goals.” Retrieved 1/13/2018. https://www.jointcommission.org/facts_about_the_national_patient_safety_goals/

Page 338: An Ethical Framework for Organizational Resource

 

330

The United Nations. Universal Declaration of Human Rights. 1948.

Thompson, P. "Seeking Common Ground in a World of Ethical Pluralism: A Review Essay of Moral Acquaintances: Methodology in Bioethics by Kevin Wm. Wildes, S.J." HEC Forum 16, no. 2 (2004): 120-128.

Thompson, Richard. "Self-Serving Altruism: Not an Oxymoron." Physician Executive 33, no. 6 (Nov/Dec 2007): 82-3.

Tomlinson, Thomas. "Futility Beyond Cpr: The Case of Dialysis." HEC Forum 19, no. 1 (Mar 2007): 33-43.

Tonelli, Mark R. "What Medical Futility Means to Clinicians." HEC Forum 19, no. 1 (Mar 2007): 83-93.

Torke, A. M., G. A. Sachs, P. R. Helft, K. Montz, S. L. Hui, J. E. Slaven, and C. M. Callahan. "Scope and Outcomes of Surrogate Decision Making among Hospitalized Older Adults." JAMA Intern Med 174, no. 3 (Mar 2014): 370-7.

Tromp, Noor, and Rob Baltussen. "Mapping of Multiple Criteria for Priority Setting of Health Interventions: An Aid for Decision Makers." BMC Health Services Research 12 (2012): 454.

Trong Tuan, Luu. "Clinical Governance, Corporate Social Responsibility, Health Service Quality, and Brand Equity." Clinical Governance 19, no. 3 (2014): 215-234.

Truog, Robert D.. "Is It Always Wrong to Perform Futile Cpr?" The New England Journal of Medicine 362, no. 6 (Feb 2010): 477-9.

Truog, Robert D.. "Tackling Medical Futility in Texas." The New England Journal of Medicine 357, no. 1 (Jul 2007): 1-3.

Tubbs, James B., Jr. A Handbook of Bioethics Terms. Washington, UNITED STATES: Georgetown University Press, 2009.

Turner, Bryan. "The Rights of Age: On Human Vulnerability." In Sociology and Human Rights: A Bill of Rights for the Twenty-First Century Thousand Oaks, California: SAGE Publications, Inc., 2012

Turner, L. "Bioethics in a Multicultural World: Medicine and Morality in Pluralistic Settings." Health Care Anal 11, no. 2 (2003): 103-104.

Turner, L. "From the Local to the Global: Bioethics and the Concept of Culture." J Med Philos 30, no. 3. (2005.)

U.S. Census Bureau. “U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now.” (2012.) www.census.gov/newsroom/releases/archives/population/cb12-243.html.

Page 339: An Ethical Framework for Organizational Resource

 

331

U.S. Department of Health and Human Services. Think Cultural Health. Retrieved January 13, 2018. https://www.thinkculturalhealth.hhs.gov

Ubel, Peter A. "Why It's Not Time for Health Care Rationing." Hastings Center Report 45, no. 2 (2018-01-13 2015): 15-19.

Ulrich, Connie M., Ann B. Hamric, and Christine Grady. "Moral Distress: A Growing Problem in the Health Professions?" The Hastings Center Report 40, no. 1 (Jan/Feb 2010): 20-2.

Umscheid, Craig A., Kendal Williams, and Patrick J. Brennan. "Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care." Journal of General Internal Medicine 25, no. 12 (Dec 2010): 1352-5.

UN Committee on Economic, Social and Cultural Rights (CESCR). “General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant).” (August 2000.)

UN General Assembly, Universal Declaration of Human Rights, 10 December 1948, 217 A (III)

UN General Assembly, International Covenant on Economic, Social and Cultural Rights. United Nations Treaty Series, vol. 993. 1966.

UN Human Rights Council, Protect, respect and remedy : a framework for business and human rights : report of the Special Representative of the Secretary-General on the Issue of Human Rights and Transnational Corporations and Other

UN Office of the High Commissioner for Human Rights (OHCHR), Fact Sheet No. 31, The Right to Health, June 2008, No. 31

UNESCO. “Universal Declaration on Bioethics and Human Rights.” (Oct 2015.)

United Nations Educational, Scientific, and Cultural Organization (UNESCO). Universal Declaration on Bioethics and Human Rights. 2005.

United Nations. “Goal 3: Ensure healthy lives and promote well-being for all at all ages.” (2015.) http://www.un.org/sustainabledevelopment/health/

United Nations. “Sustainable Development Goals.” (2015.) http://www.un.org/sustainabledevelopment/sustainable-development-goals/

United Nations. “Sustainable Development Goals: 17 Goals to Transform Our World.” (Sept 2015.) http://www.un.org/sustainabledevelopment/sustainable-development-goals/

United Nations. “Universal Declaration of Human Rights” (Dec 1948) http://www.un.org/en/universal-declaration-human-rights/

Page 340: An Ethical Framework for Organizational Resource

 

332

United States Department of Health and Human Services, Office of Minority Health. "National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining Clas Policy and Practice." Washington, 2013: 14-20.

US Department of Health and Human Services. Quality Improvement. April 2011. http://www.hrsa.gov/quality/toolbox/508pdfs/qualityimprovement.pdf

Vaismoradi, Mojtaba, Sue Jordan, and Mari Kangasniemi. "Patient Participation in Patient Safety and Nursing Input – a Systematic Review." Journal of Clinical Nursing 24, no. 5-6 (2015): 627-39.

Valtonen, Hannu. "Patient Characteristics and Fairness." The European Journal of Health Economics : HEPAC 10, no. 2 (May 2009): 179-86.

van de Wetering, E. J., N. J. van Exel, and W. B. Brouwer. "Health or Happiness? A Note on Trading Off Health and Happiness in Rationing Decisions." Value Health 19, no. 5 (Jul-Aug 2016): 552-7.

Van Den Bos, Jill, Karan Rustagi, Travis Gray, Michael Halford, Eva Ziemkiewicz, and Jonathan Shreve. "The $17.1 Billion Problem: The Annual Cost of Measurable Medical Errors." Health Affairs 30, no. 4 (2011): 596-603.

van der Weijden, Trudy, Antoine Boivin, Jako Burgers, Holger J. Schünemann, and Glyn Elwyn. "Clinical Practice Guidelines and Patient Decision Aids. An Inevitable Relationship." Journal of Clinical Epidemiology 65, no. 6 (Jun 2012): 584-9.

van Melle, Marije A., Dorien L. M. Zwart, Antoinette A. de Bont, Ineke W. M. Mol, Henk F. van Stel, and Niek J. de Wit. "Improving Transitional Patient Safety: Research Protocol of the Transitional Incident Prevention Programme." S

van Ryn, M., and J. Burke. "The Effect of Patient Race and Socio-Economic Status on Physicians' Perceptions of Patients." Soc Sci Med 50, no. 6 (2000): 813-28.

Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Washington D.C.: Georgetown University Press, 2012.

Vehmas, Simo, and T. O. M. Shakespeare. "Disability, Harm, and the Origins of Limited Opportunities." Cambridge Quarterly of Healthcare Ethics 23, no. 1 (Jan 2014): 41-7.

Venkatapuram, Sridhar, Hans-Jörg Ehni, and Abha Saxena. "Equity and Healthy Ageing." World Health Organization. Bulletin of the World Health Organization 95, no. 11 (Nov 2017): 791-92.

Veroff, David, Amy Marr, and David E. Wennberg. "Enhanced Support for Shared Decision Making Reduced Costs of Care for Patients with Preference-Sensitive Conditions." Health Affairs 32, no. 2 (Feb 2013): 285-93.

Page 341: An Ethical Framework for Organizational Resource

 

333

Visser, M., L. Deliens, and D. Houttekier. "Physician-Related Barriers to Communication and Patient- and Family-Centred Decision-Making Towards the End of Life in Intensive Care: A Systematic Review." Crit Care 18, no. 6 (Nov 18 2014): 604.

Voigt, Kristin. "Appeals to Individual Responsibility for Health." Cambridge Quarterly of Healthcare Ethics 22, no. 2 (Apr 2013): 146-58.

Vryonides, Stavros, Evridiki Papastavrou, Andreas Charalambous, Panayiota Andreou, and Anastasios Merkouris. "The Ethical Dimension of Nursing Care Rationing." Nursing Ethics 22, no. 8 (Dec 2015): 881-900.

"Vulnerability." In International Encyclopedia of the Social Sciences, edited by William A. Darity, Jr., 656-57. Detroit: Macmillan Reference USA, 2008.

Wagstaff, Adam. "Poverty and Health Sector Inequalities." World Health Organization. Bulletin of the World Health Organization 80, no. 2 (2002): 97-105.

Walczak, A., P. N. Butow, M. H. Tattersall, P. M. Davidson, J. Young, R. M. Epstein, D. S. Costa, and J. M. Clayton. "Encouraging Early Discussion of Life Expectancy and End-of-Life Care: A Randomised Controlled Trial of a Nurse-Led Communication Support Program for Patients and Caregivers." Int J Nurs Stud 67 (Feb 2017): 31-40.

Wallace, M., J. Crear-Perry, L. Richardson, M. Tarver, and K. Theall. "Separate and Unequal: Structural Racism and Infant Mortality in the Us." Health Place 45 (May 2017): 140-44.

Wallace, Steven P. "Equity and Social Determinants of Health among Older Adults." Generations 38, no. 4 (2014): 6-11.

Walley, P., & Gowland, B. "Completing the Circle: From Pd to Pdsa." International Journal of Health Care Quality Assurance 17(6) (2004): 349-58.

Washington, Donna L., Jacqueline Bowles, Somnath Saha, Carol R. Horowitz, Sandra MoodyAyers, Arleen F. Brown, Valerie E. Stone, Lisa A. Cooper, and Disparities in Health Task Force Writing group for the Society of General Internal Medicine. "Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare." Journal of General Internal Medicine 23, no. 5 (2008): 685-91.

Watson, George W., R. Edward Freeman, and Bobby Parmar. "Connected Moral Agency in Organizational Ethics." Journal of Business Ethics 81, no. 2 (2008): 323-41.

Weaver, GR. "Virtue in Organizations: Moral Identity as a Foundation for Moral Agency." Organization Studies 27, no. 3 (2006): 341-68.

Wei, Alice C., David R. Urbach, Katharine S. Devitt, Meagan Wiebe, Oliver F. Bathe, Robin S. McLeod, Erin D. Kennedy, and Nancy N. Baxter. "Improving Quality through Process Change: A Scoping Review of Process Improvement Tools in”

Page 342: An Ethical Framework for Organizational Resource

 

334

Wei-Ching, Chang, and Joy H. Fraser. "Cooperate! A Paradigm Shift for Health Equity." International Journal for Equity in Health 16 (2017).

Weinick, R. M., and N. A. Krauss. "Racial/Ethnic Differences in Children's Access to Care." Am J Public Health 90, no. 11 (2000): 1771-4.

Weisleder, P. "Health Care Rationing in a Just Society: The Clinical Effectiveness Model." Semin Pediatr Neurol 22, no. 3 (Sep 2015): 201-4.

Weissman, J. S., J. Betancourt, E. G. Campbell, E. R. Park, M. Kim, B. Clarridge, D. Blumenthal, K. C. Lee, and A. W. Maina. "Resident Physicians' Preparedness to Provide Cross-Cultural Care." JAMA 294, no. 9 (2005):1058-67.

Welie, Jos V. "Social Contract Theory as a Foundation of the Social Responsibilities of Health Professionals." Medicine, Health Care, and Philosophy 15, no. 3 (2012): 347-55.

Weng, Suzie S. PhD M. S. W., and Warren T. I. I. I. M. S. W. Wolfe. "Asian American Health Inequities: An Exploration of Cultural and Language Incongruity and Discrimination in Accessing and Utilizing the Healthcare System." International Public Health Journal 8, no. 2 (2016): 155-67.

White, D. B., N. Ernecoff, P. Buddadhumaruk, S. Hong, L. Weissfeld, J. R. Curtis, J. M. Luce, and B. Lo. "Prevalence of and Factors Related to Discordance About Prognosis between Physicians and Surrogate Decision Makers of Critically Ill Patients." Jama 315, no. 19 (May 17 2016): 2086-94.

White, N., N. Kupeli, V. Vickerstaff, and P. Stone. "How Accurate Is the 'Surprise Question' at Identifying Patients at the End of Life? A Systematic Review and Meta-Analysis." BMC Med 15, no. 1 (Aug 2 2017): 139.

Whitley, Rob, Cecile Rousseau, Elizabeth Carpenter-Song, and Laurence J. M. D. Frcpc Kirmayer. "Evidence-Based Medicine: Opportunities and Challenges in a Diverse Society." Canadian Journal of Psychiatry 56, no. 9 (Sep 2011): 514-22.

Wilkinson, D. J. C. "Rationing Conscience." Journal of Medical Ethics: The Journal of the Institute of Medical Ethics 43, no. 4 (2018-01-13 2017): 226-29.

Wilkinson, D., and J. Savulescu. "Cost-Equivalence and Pluralism in Publicly-Funded Health-Care Systems." Health Care Anal (Jan 6 2017).

Wilkinson, G. W., A. Sager, S. Selig, R. Antonelli, S. Morton, G. Hirsch, C. R. Lee, et al. "No Equity, No Triple Aim: Strategic Proposals to Advance Health Equity in a Volatile Policy Environment." Am J Public Health 107, no. S3 (Dec 2017): S223-S28.

Willen, Sarah S., Michael Knipper, César E. Abadía-Barrero, and Nadav Davidovitch. "Syndemic Vulnerability and the Right to Health." The Lancet 389, no. 10072 (2017): 964-77.

Page 343: An Ethical Framework for Organizational Resource

 

335

Williams Jr, Ralph I et al. "Reinvigorating the Mission Statement through Top Management Commitment." Management Decision 52, no. 3 (2014): 446.

Williams, David R., Naomi Priest, and Norman B. Anderson. "Understanding Associations among Race, Socioeconomic Status, and Health: Patterns and Prospects." Health Psychology 35, no. 4 (2016): 407-11 5p.

Williams, David R., Naomi Priest, and Norman B. Anderson. "Understanding Associations among Race, Socioeconomic Status, and Health: Patterns and Prospects." Health Psychology 35, no. 4 (2016): 407-11 5p.

Williams, I. "Receptive Rationing: Reflections and Suggestions for Priority Setters in Health Care." J Health Organ Manag 29, no. 6 (2015): 701-10.

Wilmot, Stephen. "Corporate Moral Responsibility: What Can We Infer from Our Understanding of Organizations?" Journal of Business Ethics 30, no. 2 (Mar 2001): 161-69.

Wilson, M. E., A. Akhoundi, A. K. Krupa, R. F. Hinds, J. M. Litell, O. Gajic, and K. Kashani. "Development, Validation, and Results of a Survey to Measure Understanding of Cardiopulmonary Resuscitation Choices among Icu Patients and Their Surrogate Decision Makers." BMC Anesthesiol 14 (Mar 8 2014): 15.

Wilson, Sacoby, Hongmei Zhang, Chengsheng Jiang, Kristen Burwell, Rebecca Rehr, Rianna Murray, Laura Dalemarre, and Charles Naney. "Being Overburdened and Medically Underserved: Assessment of This Double Disparity for Populations in the State of Maryland." Environmental Health 13 (2014): 26.

Wilson-Mitchell, K., and M. Handa. "Infusing Diversity and Equity into Clinical Teaching: Training the Trainers." J Midwifery Womens Health 61, no. 6 (Nov 2016): 726-36.

Winkler, Eva C and Russell L. Gruen. Organizational Ethics. The Sage Handbook of Health Care Ethics: Core and Emerging Issues. Sage Publications Ltd. London: SAGE Publications Ltd, 2011. 75-76.

Wiseman, Virginia L. "Inclusiveness in the Value Base for Health Care Resource Allocation." Social Science & Medicine 108 (May 2014): 252-56.

Wittenberg, E., B. Ferrell, J. Goldsmith, H. Buller, and T. Neiman. "Nurse Communication About Goals of Care." J Adv Pract Oncol 7, no. 2 (Mar 2016): 146-54.

Woodard, Tanisha D. "Addressing Variation in Hospital Quality: Is Six Sigma the Answer?" Journal of Healthcare Management 50, no. 4 (Jul/Aug 2005): 226-36.

Woods, L. L., 2nd, M. Shaw-Ridley, and C. A. Woods. "Can Health Equity Coexist with Housing Inequalities? A Contemporary Issue in Historical Context." Health Promot Pract 15, no. 4 (Jul 2014): 476-82.

Page 344: An Ethical Framework for Organizational Resource

 

336

World Health Organization. “Health and Human Rights.” Factsheet No 323. (Dec 2015.) http://www.who.int/mediacentre/factsheets/fs323/en/

World Health Organization: Commission on Social Determinants of Health, 2005-2008. A conceptual framework for action on the social determinants of health. 2007.

Wouters, S., N. J. van Exel, K. I. Rohde, and W. B. Brouwer. "Are All Health Gains Equally Important? An Exploration of Acceptable Health as a Reference Point in Health Care Priority Setting." Health Qual Life Outcomes 13 (Jun 10 2015): 79.

Yamin, Alicia Ely, and Angela Duger. "Adjudicating Health-Related Rights: Proposed Considerations for the United Nations Committee on Economic, Social and Cultural Rights, and Other Supra-National Tribunals." Chicago Journal of International Law 17. (2016.)

Yamin, Alicia Ely, and Ole Frithjof Norheim. "Taking Equality Seriously: Applying Human Rights Frameworks to Resource allocation in Health." Human Rights Quarterly 36, no. 2 (May 2014): 296-324,504-05.

Yamin, Alicia Ely, and Paul Farmer. Power, Suffering, and the Struggle for Dignity : Human Rights Frameworks for Health and Why They Matter. Philadelphia: University of Pennsylvania Press, 2015. (26-41)

Yarnell, C., and R. Fowler. "The Case for Routine Goals-of-Care Documentation." BMJ Qual Saf 25, no. 9 (Sep 2016): 647-8.

Yegian, Jill Mathews, Pam Dardess, Maribeth Shannon, and Kristin L. Carman. "Engaged Patients Will Need Comparative Physician-Level Quality Data and Information About Their out-of-Pocket Costs." Health Affairs 32, no.

Yeow, Adrian, and Kim Huat Goh. "Work Harder or Work Smarter? Information Technology and Resource Allocation in Healthcare Processes." MIS Quarterly 39, no. 4 (Dec 2015): 763.

Yew Kong, Lee, Low Wah Yun, and Chirk Jenn Ng. "Exploring Patient Values in Medical Decision Making: A Qualitative Study." PLoS One 8, no. 11 (Nov 2013).

Yi Feng, Lai, Lum Andrew Yew Wai, Ho Emily Tse Lin, and Lim Yee Wei. "Patient-Provider Disconnect: A Qualitative Exploration of Understanding and Perceptions to Care Integration." PLoS One 12, no. 10 (Oct 2017).

Yuen, Jacqueline K., M. Carrington Reid, and Michael D. Fetters. "Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them." Journal of General Internal Medicine 26, no. 7 (Jul 2011): 791-7.

Zagorac, Ivana PhD. "How Should We Treat the Vulnerable? Qualitative Study of Authoritative Ethics Documents." Journal of Health Care for the Poor and Underserved 27, no. 4 (Nov 2016): 1656-73.

Page 345: An Ethical Framework for Organizational Resource

 

337

Zhang, M., J. Volovetz, and M. Teo. "Surgeon Adherence to Medical Ethics as Contingent on Their Leadership in the Changing Economics of Health Care." World Neurosurg 104 (Aug 2017): 979-80.

Zhang, Yuan, Coello Pablo Alonso, Jan Brożek, Wojtek Wiercioch, Itziar Etxeandia-Ikobaltzeta, Elie A. Akl, Joerg J. Meerpohl, et al. "Using Patient Values and Preferences to Inform the Importance of Health Outcomes in Practice Guideline Development Following the Grade Approach." Health and Quality of Life Outcomes 15 (2017).

Zimmerman, Michael J. "Responsibility." In New Dictionary of the History of Ideas, edited by Maryanne Cline Horowitz, 2110-12. Detroit: Charles Scribner's Sons, 2005.

Zuckerman, R. B., S. C. Stearns, and S. H. Sheingold. "Hospice Use, Hospitalization, and Medicare Spending at the End of Life." J Gerontol B Psychol Sci Soc Sci 71, no. 3 (May 2016): 569-80.

Zulman, Donna, Steven M. Asch, Susana B. Martins, Eve A. Kerr, Brian Hoffman, and Mary K. Goldstein. "Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness.” Journal of General Internal Medicine 29, no. 3 (2014): 529-537.