Applied ethics in health care administration: A case study of organ donation in an unidentified person

Ethical leadership in health care helps to guide the administrator through difficult decisions, upholding the policy of the institution while putting patient care first. This case study presents an ethical dilemma encountered by the administrator regarding organ procurement in an unidentified person who dies within the hospital. The purpose of this report is to provide a comprehensive literature and concept review of the bioethical considerations of organ donation in an unidentified person, to review the current status of the Uniform Anatomical Gift Act (UAGA), and to provide a review of presumed versus informed consent. These are all aspects that shape ethical decision-making for the health care administrator. Forty-eight states have adopted UAGA legislation governing regulations regarding organ donation. In states where the legislation has been enacted, the authority to consent for organ donation is granted to the custodian of the body. In the case of persons who are unidentified, individual state regulations often grant custodianship to the hospital in which the patient died. Health care administrators may be called upon to consent for hospital procedures in cases of diminished capacity and the absence of a substitute decision maker. The health care administrator needs to be well-informed about the ethical framework for decision making in order to opine regarding organ procurement based on patient autonomy and uphold the current laws and hospital policy with beneficence and integrity.

Identification and Classification of Diseases: Fundamental Problems in Medical Ontology and Epistemology

During the last three centuries there has been remarkable development in the area of the identification and classification of diseases. The taxonomic systems adopted in the 18th century by, for instance, Sauvages and Linnaeus bare no resemblance to the modern nomenclatures for pathological phenomena. The aim of this paper is to give a brief historical presentation, but also a critical analysis, of a number of crucial ideas and theories behind the construction of certain major disease classifications. My focus in the second half of the paper is on the most influential modern systems of classification, the International Statistical Classification of Diseases and Related Health Problems (ICD) and the International Systematized Nomenclature of Human and Veterinary Medicine (SNOMED). The former is the official classification adopted by the World Health Organization and is used mainly for clinical and administrative purposes. The latter is a highly complex system of classification which has recently been developed for a variety of purposes (including medical research) and is meant to be read and handled by computers. ICD, although widely used all over the world, has salient and well-known logical deficiencies. SNOMED has been introduced partly to remedy these deficiencies. I conclude, however, that SNOMED, in spite of its sophisticated resources, cannot completely replace ICD. For many clinical and administrative purposes there is need of a relatively simple system that can be handled by the ordinary doctor and the ordinary health-care administrator.