As technology advances, health care decisions have become increasingly complex. American hospitals, based on accreditation standards, are required to have a system and process to address ethics, patient rights, and responsibilities. These practices vary widely, and there is very little consistency and few standards across the country. Key court cases have provided minor structure, and the federal government has been silent in the formulation of these structures but not necessarily in this arena. Most often, these accreditation standards related to clinical ethics are managed by Healthcare Ethics Committees (HEC). Bioethics has become a growing field, the level of integration between this discipline and healthcare practice varies widely. Using qualitative methods based on Grounded Theory, this analysis presents six key thematic findings, as well as interpretations to identify current challenges and opportunities to make recommendations for improvement by enhancing clarity and reducing ambiguity.

Our health is what we value most. Medicine as a scientific branch has made a great step forward in the last decades. Due to this fact, the demographical structure of inhabitants changed significantly. People reach higher age, we are able to treat diseases, which used to cause death. Nevertheless, we are not anymore in a phase, when financial costs equal treatment needed for all people in Czech Republic. Therefore, the topic Ethics in healthcare is an actual one. The aim of this thesis is the description and following analysis of actual problems in Czech healthcare. There are stated the main problems in Czech healthcare, where the relationship between ethics and economics is mostly visible. The proposal for improving the actual situation, is to extend the Ethical code of Czech Medical Chamber, as the document, which brings the main ethical standards in healthcare. The next proposal for improving the actual situation in Czech healthcare, is to make new ethical codes for different medical specialties. It is also advised to place the Ethical code of Czech Medical Chamber on visible places. The used method is compilation of literature and interviews with professionals and medics for analytical approaches. In this thesis, data from Czech Institution for Health Information and Statistics are used. There are also used articles form healthcare magazines and from general periodicals.

Proliferation of ethics programs in healthcare organizations has occurred without rigorous evaluation. This qualitative study explored what makes an ethics program effective from the perspective of 15 practising ethicists across Canada. Objectives were to: describe how practising ethicists define ethics program effectiveness, identify evaluation strategies, and identify critical success factors. Ethicists defined effectiveness as: 1) meeting standards; 2) making a difference; and 3) delivering value for investment. To evaluate, ethicists assessed: ethics program activity data, qualitative feedback, relevant accreditation results, peer review, and pre- and post- results. Ethicist competencies and attributes, organizational understanding of, and support for, the ethics program, and a community of practice were critical success factors. Effectiveness emerged as a multi-dimensional concept. Findings provide a preliminary outline of what an ethics program evaluation framework might include and inform practice standard development, ethicist training programs, and organizational oversight for ethics programs.

Proliferation of ethics programs in healthcare organizations has occurred without rigorous evaluation. This qualitative study explored what makes an ethics program effective from the perspective of 15 practising ethicists across Canada. Objectives were to: describe how practising ethicists define ethics program effectiveness, identify evaluation strategies, and identify critical success factors. Ethicists defined effectiveness as: 1) meeting standards; 2) making a difference; and 3) delivering value for investment. To evaluate, ethicists assessed: ethics program activity data, qualitative feedback, relevant accreditation results, peer review, and pre- and post- results. Ethicist competencies and attributes, organizational understanding of, and support for, the ethics program, and a community of practice were critical success factors. Effectiveness emerged as a multi-dimensional concept. Findings provide a preliminary outline of what an ethics program evaluation framework might include and inform practice standard development, ethicist training programs, and organizational oversight for ethics programs.

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