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Decisions Near the End of Life: Resources Allocation Implications for Hospitals

Published online by Cambridge University Press:  10 December 2009

Paul B. Hofmann
Paul B. Hofmann
Affiliation:
A Consultant at the Alta Bates Corporation, a Doctor of Public Health student in health policy and administration at the University of California, Berkeley, and Chair of the American Hospital Association's Technical Panel on Biomedical Ethics
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Extract

Heathcare spending, which was almost 13% of the gross national product last year, is estimated to jump to 14% in 1992. For the first time, hosital expenditures are projected to exceed $300 biilion, representing over 38% of the nation's total healthcare bill. In an effort to reduce federal and state budget deficits and to stimulate institutional cost containment, Medicare and Medicaid officials are becoming even more parsimonious in negotitation reimbursement levels.

Type
Special Section: Hospitals and Moral Imperatives
Information
Cambridge Quarterly of Healthcare Ethics , Volume 1 , Issue 3 , Summer 1992 , pp. 229 - 237
Copyright
Copyright © Cambridge University Press 1992

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References

Notes

1. Weissenstein, E.U.S. health spending soars 11%. Modern Healthcare 1992;22:3.Google ScholarPubMed

2. Johnsson, J.CEOs: survival tips for the tough times ahead. Hospitals 1991;65:56.Google ScholarPubMed

3. Nemes, J.Decline in California rating results in downgradings of 76 hospitals' bonds. Modern Healthcare 1992;22:5.Google ScholarPubMed

4. Weissenstein, E.Healthcare costs eat 12% of family income–Report. Modern Healthcare 1991;21:15.Google Scholar

5. Gianelli, DM.Debate rages over M.D.-aided suicide. American Medical News June 22,1990; 1,27,28.Google Scholar

6. Humphrey, DH.Final Exit. Eugene, Oregon: Hemlock Society, 1991.Google ScholarPubMed

7. Anonymous. Death won't come easy to euthanasia movement. Catholic Health World 1991;7:1,4.Google Scholar

8. Hofmann, PB.When medicine no longer helps. U.S.A. Today 03 29, 1984;2:10A.Google Scholar

9. Davies, NE, Felder, LH.Applying brakes to the runaway American health care system. Journal of the American Medical Association 1990;263:73–76.CrossRefGoogle ScholarPubMed

10. Annas, GJ.Life, liberty, and death. Health Management Quarterly 1990;12:5–8.Google ScholarPubMed

11. Strosberg, MA, Fein, IA.Policy and management issues in rationing care for the critically ill. Hospital Administration Currents 1987;31:1–6.Google ScholarPubMed

12. McCarthy, CM.Final care requires us to “come to grips with our humanity.” American Hospital Association News 1990; 46:4.Google Scholar

13. Cranford, RE.Neurological syndromes and prolonged survival: when can artificial nutrition and hydration be forgone? Law, Medicine & Health 1991;19:13–22.Google Scholar

14. Anonymous. Society urged to address growing costs of medical care for terminally ill. American Medical News 03 6, 1987;49.Google Scholar

15. Biomedical Ethics: An Anglo-American Dialogue. Callahan, D, Dusten, GR, eds. Annals of the New York Academy of Sciences 1988;23.Google Scholar

16. In re Quintan, 70 N.J. 10 335 A. 2d 647 (1976).Google Scholar

17. Barber, v.Superior Court, 195 Col Rptr. 484 147 Cal. Appl. 3d 1006 (1983) (Herbert Case).Google Scholar

18. Bouvia, v.Superior Court, 225 Cal. Rptr. 297 Ct. App. (1986).Google Scholar

19. Cruzan, v.Director, Missouri Dept of Health, 110 S. Ct. 284 (1990).Google Scholar

20. Angell, M.The case of Helga Wanglie. New England Journal of Medicine 1991;325:511–512.CrossRefGoogle ScholarPubMed

21. Rouse, F.The role of state legislatures after Cruzan: what can-and should-state legislatures do? Law, Medicine & Health Care 1991;19:83–90.Google Scholar

22. See note 21.Google Scholar

23. Lehman, LB.Of dead brains, living wills, and autonomy. Hospital Practice 1991;26:39–42,45–48.CrossRefGoogle ScholarPubMed

24. Wolf, SM, Boyle, P, Callahan, D et al. , Sources of concern about the patient self-determination act. New England Journal of Medicine 1991;325:1666–1671.CrossRefGoogle ScholarPubMed

25. Robertson, JA.Second thoughts on living wills. Hastings Center Report 1991;21:6–9.CrossRefGoogle ScholarPubMed

26. Brock, DW.Triumphing advance directives. Hastings Center Report 1991;21(suppl.):5–6.CrossRefGoogle Scholar

27. Sehgal, A, Galbraith, A, Chesney, M, et al. How strictly do dialysis patients want their advance directives followed?. Journal of the American Medical Association 1992;267:59–63.CrossRefGoogle ScholarPubMed

28. Bioethics Literature Review 1991;6.Google Scholar

29. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Summing Up–Final Report on Studies of the Ethical and Legal Problems in Medicine and Biomedical and Behavioral Research Washington, D.C.:U.S. Government Printing Office, 1983.Google ScholarPubMed

30. American Hospital Association. Values in Conflict: Resolving Ethical Issues in Hospital Care. Chicago: American Hospital Association, 1985.Google Scholar

31. Hofmann, PB. A summary of values in conflict: resolving ethical issues in hospital care. In. Friedman, E, ed. Making Choices: Ethics Issues for Health Care Professionals. Chicago:American Hospital Publishing, 1986 169–174.Google Scholar

32. Anonymous. It's over, Debbie. Journal of the American Medical Association 1988;259:272.Google ScholarPubMed

33. Pertone, J.Subpoena quashed over “Debbie” essay. American Medical News 1988 Apr. 1;4.Google Scholar

34. Lundberg, GD.“It's over, Debbie” and the euthanasia debate. Journal of the American Medical Association 1988;259:2142–2143.CrossRefGoogle ScholarPubMed

35. Richards, B.AMA Journal's letter from mercy killer raises legal debate on source protection. The Wall Street Journal Feb. 22, 1988;21.Google Scholar

36. Siegler, M.The AMA euthanasia fiasco. The New York Times Feb. 26, 1988;23.Google Scholar

37. Bloom, M.Article embroils JAMA in ethical controversy. Science 1988;239:1235–1236.CrossRefGoogle ScholarPubMed

38. See note 34.Google Scholar

39. Quill, T.Death and dignity–a case of individualized decision-making. The New England Journal of Medicine 1991;324:691–694.CrossRefGoogle Scholar

40. Phillips, DE.Rising tide of euthanasia support turns to ripples of caution. Hospital Ethics 1991;7:2–3.Google Scholar

41. Nelson, H.U.S. medical cost: we're all to blame. Los Angeles Times 1977 Jul. 17;1.Google Scholar

42. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, D.C.:U.S. Government Printing Office, 1982.Google Scholar

43. Brock, DW, Wartman, SA.When incompetent patients make irrational choices. The New England Journal of Medicine 1990;322:1595–1599.CrossRefGoogle Scholar

44. Chervenak, FA, McCullough, LB.Justified limits on refusing intervention. Hastings Center Report 1991;21:12–18.CrossRefGoogle ScholarPubMed

45. Miles, SH.Authonomy' responsibility. Health Progress 1991;72:30–31, 62.Google ScholarPubMed

46. Frankel, D, Oye, RK, Bellamy, PE.Attitudes of hospitalized patients toward life support: a survey of 200 medical inpatients. The American Journal of Medicine 1989;86:645–648.CrossRefGoogle Scholar

47. Fine, RL.Personal choices: communication between physicians and patients when confronting critical illness. The Journal of Clinical Ethics 1991;2:57–62.Google ScholarPubMed

48. Lo, B.Assessing decision-making capacity. Law, Medicine and Health Care 1990;18:193–201.Google ScholarPubMed

49. McCloskey, E.Between isolation and intrusion: the patient self-determination act. Law, Medicine and Health Care 1991;19:80–82.Google ScholarPubMed