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Organizational Ethics for Sponsorship and Governance in Catholic Healthcare Alex Garvey Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 2015 Organizational Ethics for Sponsorship and Governance in Catholic Healthcare Alex Garvey Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Garvey, A. (2015). Organizational Ethics for Sponsorship and Governance in Catholic Healthcare (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/570 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. ORGANIZATIONAL ETHICS FOR SPONSORSHIP AND GOVERNANCE IN CATHOLIC HEALTHCARE A Dissertation Submitted to the Center for Healthcare Ethics McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Alex Garvey, M.A.P.T. February, 2015 Copyright by Alex Garvey, M.A.P.T. 2015 ORGANIZATIONAL ETHICS FOR SPONSORSHIP AND GOVERNANCE IN CATHOLIC HEALTHCARE By Alex Garvey, M.A.P.T Approved March 23rd, 2015 ________________________________ ________________________________ Gerard Magill, PhD Henk ten Have MD, PhD Vernon F Gallagher Chair Professor, Center for Healthcare Ethics Professor, Center for Healthcare Ethics (Committee Member) (Dissertation Chair) ________________________________ ________________________________ Joris Gielen, PhD Henk ten Have, MD, PhD Assistant Professor Director, Center for Healthcare Ethics Center for Healthcare Ethics (Center Director) (Committee Member) ________________________________ James Swindal, PhD Professor and Dean, McAnulty College and Graduate School of Liberal Arts iii ABSTRACT ORGANIZATIONAL ETHICS FOR SPONSORSHIP AND GOVERNANCE IN CATHOLIC HEALTHCARE By Alex Garvey, M.A.P.T. May 2015 Dissertation supervised by Professor Gerard Magill Catholic healthcare in the U.S. is distinctive in its organizational structure insofar as it typically has Sponsorship as well as Governance oversight, reflecting the Catholic social tradition and organizational ethics to engage both patient care and the public good. Sponsorship deals with the mission and identity of Catholic organizations to ensure that they implement the Catholic social tradition. Governance deals with organizational ethics to ensure that the organization’s values (reflecting its mission and identity) influence all aspects of the institution. Because these are intricately connected, the dissertation deals with them in an integrated manner, hence the combined focus upon Sponsorship and Governance oversight. To express this integrative approach the analysis refers to organizational ethics (implementing the perspective of the Catholic social tradition) for Sponsorship and Governance in Catholic healthcare. iv This oversight is explained with regard to specific issues. There needs to be enhanced oversight of current issues as well as intense oversight of emerging trends. Enhanced oversight requires more attention to current issues that Catholic healthcare typically engages insofar as they have changed slightly, reflecting revised Church teaching or changing secular awareness. These issues relate both to patient care (such as end of life care or withdrawing futile life-sustaining treatment) and to the public good (such as rationing, minorities in research, vaccinations, or antibiotics). Intense oversight requires more vigorous attention to deal with emerging trends that are pivotal for Catholic healthcare, reflecting the changing landscape of healthcare itself. These trends also relate to patient care (such as quality and safety) and to the public good (such as community benefit programs and conflicted organizational partnerships). v DEDICATION To my Father, Denis, who was a kind and gentle Spirit To my wife Tricia for her friendship and love And our son Finbarr, may he shine. vi ACKNOWLEDGEMENT Be yourself. Everyone else is already taken. (Oscar Wilde) The completion of this work is the collimation of a life’s journey. On my travels, I have been supported both intellectually and spiritually by a wonderful family and great friends. Many are with fond memories and all remain close to my heart. I would like to begin by thanking my dissertation Director, Dr. Gerard Magill, for his kind guidance, continuous encouragement and ongoing support. His keen vision was invaluable to me. He provided constant insight and advice during this entire process, especially when I was questioning or doubting. Thanks also, to Dr. Hank ten Have for his openness, engagement and for our great discussions. I appreciate all the Staff at Duquesne Department of Healthcare Ethics, particularly Ms. Glory Smith. Her kind demeanor, warm smile, and willingness to go above and beyond encompasses the true Spiritan Tradition. I would like to thank Bon Secours’ HealthCare Ministry, both as a PJP, and as a system for allowing their associates to flourish. Particularly, Sr. Rita Thomas, John Wallenhorst, Joseph Driscoll, Joseph Oddis and Pam Phillips, your friendship, guidance and support have been invaluable. Thank you all for your encouragement and for helping me to believe. Thanks to my many friends who have seen me through the great and often difficult moments in my life. Especially Fergus Garvey, Patrick Handrahan, Noel O’Connor, Jim Nero, John Mullet, Charles Kiley and Bert O’Connor. I appreciate you for often knowing me better than I know myself. Gratitude is due to my brothers, Sean and Fergus, we have sojourned. Finally, a special word of thanks to my beautiful wife Tricia. Her friendship, companionship and patience over these many years have been remarkable. She has stood with me and allowed me to be. For our son, Finbarr and the unconditional love he shares. I would like to remember my parents, Denis and Treasa, in a special way, for instilling in me a sense of love for our poor, may they rest in peace vii TABLE OF CONTENTS Page Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgement ............................................................................................................ vii Chapter 1. Introduction 1 Chapter 2. Sponsorship & Governance Oversight and Organizational Ethics. 42 a. Catholic Social Tradition. i. Dignity, Sanctity, and Community. ii. Right to Healthcare b. Organizational Ethics. i. Public Trust: Solidarity & Subsidiarity. ii. Organizational Integrity & Responsibility. c. Sponsorship Oversight. i. History of Sponsorship. ii. Public Juridic Person. d. Governance Oversight. i. History of Governance. ii. Board Duties and Organizational Mission. e. Conclusion. Chapter 3. Enhanced Oversight of Patient Care: End of Life Care. 113 a. Autonomy & End of Life Care. i. Ordinary & Extraordinary Means. ii. Advanced Directives. iii. Brain Death Diagnosis. b. Withdrawing Futile Treatment. i. Suffering and Dying. ii. Pope John Paul II & the Ethical and Religious Directives #58. iii. Assisted Suicide and Euthanasia. c. Conclusion. Chapter 4. Enhanced Oversight of the Public Good: Illustrative Issues. 164 a. Rationing of Healthcare. i. Right to Healthcare. ii. Catholic Principles for Rationing Healthcare. b. Minorities in Research. i. Federal Regulations. ii. Vulnerable Populations. c. Mandatory Vaccinations. viii i. Ethical Principles Related to Vaccination. ii. Vaccination for Healthcare Workers. d. Over-Use of Antibiotics. i. Food Chain. ii. Health Care. e. Conclusion. Chapter 5. Intensive Oversight of Patient Care: Quality & Safety. 220 a. Oversight Responsibility. (i) Institute of Medicine Report. (ii) National Scorecard on U.S. Health System Performance. b. Medical Error. (i) Iatrogenic Harm. (ii) Theory of Error. c. Professional Sanctions vs Patient Safety Models. (i) Focus on Individuals. (ii) Focus on Systems. d. Root Cause Analysis. (i) Adverse Events. (ii) Procedures. e. Culture of Patient Safety. (i) Patient Care Quality. (ii) Patient Participation. f. Conclusion. Chapter 6. Intensive Oversight of Public Good: Community Benefit Programs. 267 a. Community Benefit Standard. (i). Scrutiny of the Community Benefit Requirement. (ii). Ethical Framework for Community Benefit Responsibilities. b. Oversight Responsibility: the Catholic Health Association Approach. (i). Healthcare Mission, Community Needs and Environment. (ii). Compliance with the Internal Revenue Service Form 990. c. Conclusion. Chapter 7. Intensive Oversight of Conflicted Organizational Partnerships. 300 a. Principle of Double Effect (PDE). (i) The Principle’s Four Categories. (ii) Case Examples of Double Effect. b. Principle of Cooperation. (i) Formal Cooperation. (ii) Material Cooperation. c. Organizational Partnerships: Conflicted Cases. (i) Seton Medical Center, Austin, Texas. (ii) St. Vincent’s Hospital, Denver, Colorado. d. Conclusion. ix Chapter 8. Conclusion: Implications of Governance and Sponsorship Oversight. 349 a. Organizational Ethics for Sponsorship and Governance Oversight. b. Enhanced Oversight of Patient Care and the Public Good. Intensive Oversight of Patient Care and the Public x Chapter 1. Introduction. There has been significant discussion of the meaning of Religious Sponsorship in Church Canon Law from a
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