tag:blogger.com,1999:blog-7476621888383604834.post7308019802064027744..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Tragic Choices at Grady HospitalJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7476621888383604834.post-30159218287805794272009-12-30T09:32:31.415-05:002009-12-30T09:32:31.415-05:00Dear Anonymous -
Thank you for your thoughtful co...Dear Anonymous -<br /><br />Thank you for your thoughtful comment. I didn't know anything about the initial decision-making process, but I couldn't agree more with your emphasis on a transparent process that provides clear justification. The core argument Norman Daniels and I make in <em>Setting Limits Fairly</em> is about the need for fair process.<br /><br />I did find on the web a November 2 presentation made to the board about the status of the patients who had been receiving dialysis. That kind of posting contributes to the openness you call for. <br /><br />The dialysis clinic decision is about as difficult as could be imagined for Grady to handle, since the danger of direct and relatively immediate loss of life is involved. Years ago, when I was working at a neighborhood health center in a poor area of Boston, I saw how each year the center moved to the brink of firing its invaluable public health nurses as part of its annual budget battle. That was bad, but putting patients as vulnerable as those the dialysis clinic into the middle is vastly worse. The underlying message is "We'll be happy to continue caring for the patients, but we can only do it if you [the public, through its agencies] provide the funding" may be 100% true. but it's hard for the public to hear the message when what the Brits call "shroud waving" is going on.<br /><br />In addition to its public statements, I hope Grady is telling the patients - "Grady Hospital can't continue paying for your dialysis forever, but we won't leave you in the lurch..."<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-61492593141875834042009-12-30T07:54:04.729-05:002009-12-30T07:54:04.729-05:00Dr. Sabin,
While I agree with everything you say...Dr. Sabin, <br /><br />While I agree with everything you say in this blog entry, I think one of the major problems with Grady deciding to close it's dialysis clinic was the decision-making process.<br />The decision was made behind closed doors (an executive session of the board meeting) without public involvement. It lacked transparency, justification, inclusiveness and revisability.<br /><br />While I don't see any particular problems with choosing to close one service over another, I think the process used must be "fair and reasonable." And when the board decides it is going to close one service over another it appears that community involvement, outside of the business community, is essential to fairness.Anonymousnoreply@blogger.com