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Ethics in the trenches: translating ethical principles into practice in health care institutions.
Anderson ES; Group Health Cooperative of Puget Sound, Seattle,
December 30, 1990
Int Conf AIDS. 1990 Jun 20-23;6(3):108 (abstract no. S.C.49). Unique

OBJECTIVE: Through case studies, to present the challenges involved in translating ethical principles into practice at health care institutions. METHODS and RESULTS: When ethical principles related to the provision of health care (e.g. protection of human subjects, informed consent, confidentiality, workplace safety) are applied to day-to-day practice, they are tempered by the reactions of providers and consumers. The following case studies illustrate this: 1) An HMO was debating participation in CDC's anonymous HIV seroprevalence study. When a local newspaper printed an article about secret AIDS research, the ensuing public reaction necessitated public education about the balancing of individual rights with the benefits of public health research, anonymous research protocols and informed consent. 2) Staff at a hospital with policies on universal body substance precautions and patient confidentiality debated labeling appropriate charts Blood and body substance precautions. Lengthy discussions led to guidelines which balanced patients' confidentiality rights and the staff's right to appropriate information. 3) The lag time between public announcement of clinical trial results and their publication in scientific journals puts patients, physicians, and insurers in the position of being pressured to make treatment and coverage decisions without the clinical data needed to evaluate potential benefits and harm. CONCLUSION: Mission statements, codes of ethics, and operating policies and procedures are common vehicles organizations use to state their values and to set standards of acceptable behavior. Each approach has its pros and cons. In Group Health's experience, a more successful approach has been building consensus around standards of practice and behavior that incorporate both the values articulated in mission statements and codes of ethics and the specificity of individual policies and procedures.

Acquired Immunodeficiency Syndrome/*PREVENTION & CONTROL Confidentiality *Ethics, Institutional *Health Facilities Health Maintenance Organizations Health Planning Guidelines *Health Policy Human Human Rights HIV Seroprevalence Informed Consent United States ABSTRACT