This is a case that speaks directly to the issue
of an organization's mission. As private insurance
and government reimbursement decline, the economic pressures
facing healthcare systems both public and private continue
to increase. For many institutions it is no longer a question
of prospering but surviving. As this case accurately describes,
survival is dependent on continually reducing costs and
maximizing reimbursement. These strategies often include
reducing the number of nonpaying or charity cases while
attempting to remain faithful to the mission of the organization,
whether this be a religious or civic mission. The ethics
committee, although it may be an appropriate forum for
discussions to begin concerning this patient, is not the
appropriate decisionmaking body regarding whether this
gentleman receives the treatment he needs. That task should
fall to whichever group defines or articulates the mission
and values for the organization, normally the hospital's
administration in concert with the board of directors or
trustees.