Hospital topics
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Hospitals need to assure themselves that advance directives are available to caregivers, especially physicians, and that the patient's wishes expressed in them are being followed. This can be done only with data collection and analysis and improvement of the processes that support availability and use of advance directives. On a broader, societal perspective, it has been suggested that wide-spread use of advance directives such as natural death act declarations might encourage systematic rationing of healthcare to the elderly. ⋯ Regardless of true motives, such suggestions are often seen as motivated by economics. The hospital must be alert to the ethical issues of advance directives, which are present regardless of a natural death act statute or a living will. Hospitals and their managers must consider these issues prospectively and develop policies that enable them to respect and meet patients' wishes, consistent with the organizational philosophy.
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Market-driven healthcare reform is now a reality. As the federal government grapples to control open-ended entitlements, Medicare and Medicaid, and as the private and public sectors continue to wrestle with the costs of healthcare coverage and delivery, it is useful to review the Canadian healthcare system. ⋯ Canada's system deserved another look in light of current U. S. interest in healthcare reform.