Kelsey Berry

To many participants in today’s US health-care system, it can seem as if health care has lost its way. Complex, fragmented systems. Difficulty accessing care. Strain on physicians. Financial burdens for patients. Yet there are also many opportunities to improve care, patient and provider experience, and—ultimately— health. It won’t be easy, according to SCAN Group and Health Plan President and CEO, Dr. Sachin Jain, MD, MBA. It requires nothing less than examining the paradigms of thought and practice that tend to maintain “business as usual” in the health-care industry. It will require reenvisioning mission, moral leadership, and what patient-centeredness means in health care.

The ethical obligations of health-care delivery organizations are complex, often generating deep disagreements about what justice requires of organizations operating within unjust social conditions. This article maps such disagreements onto the implicit tension between ideal and nonideal perspectives on justice and offers a dynamic way of bridging them. The ideal-nonideal tension and its potential resolution are illustrated with an organizational ethics case on social and medical care integration. By identifying and relating ideal and nonideal perspectives in a dynamic framework, the authors offer a new set of analytic and pragmatic tools by which health-care managers can navigate a broad range of complex questions of organizational ethics and health justice.

In recent years, hospitals and health-care systems across the United States have publicly committed to advancing equity and justice in health care. These pledges—often issued in the wake of the COVID-19 pandemic and national calls for racial justice—reflect an urgent awareness of longstanding disparities and the ethical imperative to address them. Yet the gap between aspirational commitments and tangible, systemic change remains wide. This Special Issue, Organizational Ethics and the Promise of Justice in Health Care, seeks to interrogate that gap.Our aim is to contribute meaningfully to the development of organizational ethics within health care, a domain of bioethical inquiry that has long lagged behind its... Read More.

Many health care organizations made public commitments to become antiracist in the wake of George Floyd's murder. These actions raise questions about the appropriateness of health care's engagement in racial justice and social justice movements generally. We argue that health care organizations can be usefully thought of as having two roles: a functional role to care for the sick and a meta‐role as an organizational citizen. Fulfilling the role of citizen may require participating in the pursuit of social justice, including efforts to achieve racial equity. The demands of these two roles will need to be balanced, but the role of organizational citizen has been largely ignored and merits serious attention.

Over the past twenty-five years, thirty-seven states and the US Congress have passed mental health and substance use disorder (MH/SUD) parity laws to secure nondiscriminatory insurance coverage for MH/SUD services in the private health insurance market and through certain public insurance programs. However, in the intervening years, litigation has been brought by numerous parties alleging violations of insurance parity. We examine the critical issues underlying these legal challenges as a framework for understanding the areas in which parity enforcement is lacking, as well as ongoing areas of ambiguity in the interpretation of these laws. We identified all private litigation involving federal and state parity laws and extracted themes from a final sample of thirty-seven lawsuits. The primary substantive topics at issue include the scope of services guaranteed by parity laws, coverage of certain habilitative therapies such as applied behavioral analysis for autism spectrum disorders, credentialing standards for MH/SUD providers, determinations regarding the medical necessity of MH/SUD services, and the application of nonquantitative treatment limitations under the 2008 federal parity law. Ongoing efforts to achieve nondiscriminatory insurance coverage for MH/SUDs should attend to the major issues subject to private legal action as important areas for facilitating and monitoring insurer compliance.

Transplantation programs commonly rely on clinicians’ judgments about patients’ social support (care from friends or family) when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is undermined by its reliance on tenuous evidence. Moreover, social support requirements may reinforce transplant inequities, interfere in patients’ personal relationships, and contribute to biased and inconsistent listing procedures. As such, accommodating the needs of patients with limited social support would better balance ethical commitments to equity, utility, and respect for persons in transplantation. We suggest steps for researchers, transplantation programs, and policymakers to improve fair use of social support in transplantation.