Is the Hospital Getting Sick? Hospital Routine between Ethical Requirements and Cost Pressure

Rapid changes in day-to-day hospital operations are increasingly challenging the ethical foundations of the medical and nursing professions and raise the question whether medical and nursing care will be able to remain focused exclusively on the well-being of the patient. Since 2003, for example, the reimbursement of treatment costs is no longer based on an individual patient’s treatment, but instead a lump sum payment is provided for each specific diagnosis, independent of the patient’s course of disease. The fact that hospitals and physicians are dependent on this reimbursement system, coupled with the development of costly new diagnostic and therapeutic options, is leading to a doctor-patient relationship that is increasingly burdened by economic aspects.

Against this background, and in connection with processes of rationing and prioritisation in inpatient health care, frameworks for clinical services are emerging which, for many physicians and nurses, can hardly be reconciled with the demands of their professional ethos. This often leads to demotivation and resignation among hospital staff. A shortage of junior staff and the danger of worrying changes in the ethical basis of the health care professions and the health care system are consequences of these developments.

At its autumn conference, the German Ethics Council addresses the conflicting demands of ethical standards and economic realities in hospitals in a differentiated manner based on multiple perspectives from theory and practice. Above all, the event encourages a discussion about constructive solutions, showing that ethical requirements and economic goals are not incompatible.

The event focuses on the following questions:

• Which economic and structural aspects are involved in the recent changes in the functioning of hospitals?
• What ethical questions and problems arise in daily hospital routine in the context of these developments?
• How can existing hospital structures and economic requirements be optimised while taking ethical demands into account?