Integrity in Health Care Institutions : Humane Environments for Teaching, Inquiry, and Healing

Covenant, Leadership, And Value Formation In Academic Health Centers / Roger J. Bulger -- Medical Institutions And Their Moral Constraints / Stephen Toulmin -- Integrity, Humaneness, And Institutions In Secular Pluralist Societies / H. Tristram Engelhardt, Jr. -- Institutions And The Shaping Of Character / Robert Coles -- Approaching Ethical Questions : A University Perspective / Daniel Steiner -- Values And The Advance Of Medical Science / Donald S. Fredrickson -- Values In Teaching And Learning : A Student-teacher Dialogue / Kim Dunn And Ruth Ellen Bulger -- Hospitals As Humane Corporations / Stanley Joel Reiser -- The Hospital-academic Health Center Interface : The Community Of Practice And The Community Of Learning / Mitchell T. Rabkin. Determinants Of The Culture And Personality Of Institutions / James G. Haughton -- The Revival Of Community And The Public Obligation Of Academic Health Centers / Lawrence W. Green -- Values And Academic Health Centers : A Commentary And Recommendations / Edmund D. Pellegrino. Edited By Ruth Ellen Bulger And Stanley Joel Reiser. Includes Bibliographical References. The twelve essays in this stimulating volume, written by health care professionals and others working with the important issue of institutional ethics, focus on the world of academic health centers and provide rich, informed commentaries on significant problems integral to the character and work of those centers. Daniel Steiner demonstrates how the viability of independent research may be threatened by university liaisons with industry. Donald Frederickson traces the history of the National Institutes of Health response to the ethical challenges in clinical investigation and fetal research. Edmund Pellegrino recommends ways in which health-related institutions may translate their concern into action. Robert Coles examines the tensions between institutional and personal values in a very provocative way. Other directions are explored by essayists Roger Bulger, Stephen Toulmin, H. Tristram Engelhardt, Kim Dunn, Mitchell Rabkin, James Haughton, Lawrence Green, and the editors themselves. Every essay in this wide-ranging collection reveals the implications and effects of institutional values. The end result is a clear picture of conflicts of values: ethical, social, economic, ethnic, cultural, and pedagogic. Integrity in Health Care Institutions points out the need for a deliberate attempt to sort out the values of institutions and, when they are fully and clearly displayed, to use priorities as a guide to satisfying the obligations of academic health centers to those who work within their walls; to the patients, students, scientists, and teachers they serve; and to society in general. Physicians and nurses, hospital and university administrators, attorneys, sociologists, and everyone concerned about the moral interaction between institutions and individuals will want to read this book. This book of essays focuses on the diminution of trust resulting from a perceived diminution in individual and institutional integrity as they relate to our university-based health educational and care programs. Following an introduction titled "Covenant, Leadership, and Value Formation in Academic Health Centers" (Roger J. Bulger), the first three essays treat the relationship between values expressed by institutions and those of individuals: "Medical Institutions and Their Moral Constraints" (Stephen Toulmin), "Integrity, Humaneness, and Institutions in Secular Pluralist Societies" (H. Tristram Engelhardt, Jr.), and "Institutions and the Shaping of Character" (Robert Coles). The next three essays consider the university and its role in forming and transmitting the values of expanding and conveying knowledge. They are titled: "Approaching Ethical Questions: A University Perspective" (Daniel Steiner); "Values and the Advance of Medical Science" (Donald S. Fredrickson), "Values in Teaching and Learning: A Student-Teacher Dialogue" (Kim Dunn and Ruth Ellen Bulger). Finally, how the values underlying institutional actions and policies are selected and what influence these values have on the treatment of individuals is the subject of "Hospitals as Humane Corporations" (Stanley Joel Reiser); "The Hospital-Academic Health Center Interface: The Community of Practice and the Community of Learning" (Mitchell T. Rabkin); "Determinants of the Culture and Personality of Institutions" (James G. Haughton); and "The Revival of Community and the Public Obligation of Academic Health Centers" (Lawrence W. Green). A concluding essay by Edmund D. Pellegrino is titled "Values and Academic Health Centers: A Commentary and Recommendations." References accompany some of the papers. (JB)