Healthcare institution partnerships--the ethical perspective.

hile ethical issues have always been a fundamental consideration in healthcare, the unprecedented surge of restructuring involving partnerships, has crystallized its relevance. For denominational hospitals, Catholic hospitals in particular, it raises questions intrinsic to the nature and mission of the organizations themselves. I was fascinated by the opening sentence of a recent commentary in Linacre Quarterly (May 1996), the official journal of the National Federation of Catholic Physicians' Guilds, in which The Reverend Russell E. Smith, S.T.D., stated that “In the past three years, one of the most common consultation requests submitted to the Pope John Centre has been for assistance in the ethical assessment of proposed hospital partnerships between Catholic and non-Catholic providers." The topic of Reverend Smith's commentary was “Ethical Quandary – Forming Hospital Partnerships.” This quandary is not limited to Catholic hospitals. The issues – such as mission compatibility, community needs and social justice, institutional culture, consistent organizational and clinical practices, treatment of employees, disposition of assets – to varying degrees confront every organization undergoing some form of partnership, whether a total merger or a consolidation of one or two departments. Susan Rubin and Laurie Zoloth-Dorfman, co-founders of Ethics Practice, a firm devoted to bioethics consultation, underscored this point in Modern Healthcare (August 1996), where they wrote “Healthcare consolidation raises ethical questions ... in raising these questions, we're not claiming that moves towards economies of scale, efficiency or prudent use of resources are inherently evil ... but are mergers, morals and medical goals consistent? ... the ethical questions that are present in all of them are whether consolidation is in the best interest of stakeholders and whether the proliferation of new corporate relationships are properly motivated." These questions, and more, characterize the broad scope of ethical challenges on both macro (e.g., mission, policy issues) and micro (e.g., employee and clinical practice issues) levels. For the purpose of this commentary, however, I would like to pay particular attention to the questions pertaining to four core issues.