Health care ethics programs in U.S. Hospitals: results from a National Survey

Background As hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking. Methods Based on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs. Results Among 372 hospitals whose informants responded to an online survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds. Conclusions While this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs.

Teaching Accounting Ethics Using Ex Corde Ecclesiae

Research has shown that in the private sector, values-based ethics programs are more effective than compliance-based ethics programs (Trevino et al. 1999). Since religious affiliations are a significant driver of values-based behavior, it is appropriate to investigate the means of formally applying a values schema rather than allowing such factors to determine the pedagogy on an ad hoc basis. This paper uses the example of the Catholic Church’s Apostolic Constitution Ex Corde Ecclesiae as a guide for designing and implementing a values-based ethics course to fulfil the educational ethics requirements to sit for the CPA exam. A classroom strategy is presented for use that helps students select priorities that align their values with a successful career in accounting. The paper then addresses the process of teaching students how to address and reconcile individual values, organizational culture, social mores, and the client’s expectations.