1. The existence of a hospital implies the existence of systems and structures of responsibility and appropriate practitioner and administrative roles that are clearly defined. Nothing about clarity of definition per se necessarily interfered with the limits of practitioner discretion or authority as far as the lines of administrative responsibility and power are concerned. Yet the case of Widener demonstrates the potential for misunderstanding when behavior of persons on the line needlessly conceals readily available information from recipients of care. It is as if the cardiologist failed to be fully informative to Widener because she did not wish to have to explain policy. On the other hand, the nurse down the line was in the position of justifying practitioner behavior, not on account of practitioner qualifications but on account of our system, our policy, our teaching hospital.
The administrative policy structure, which was concealed from the patient before the operation, was used to pressure justification of medical behavior after the operation. Further, the policy was asserted as a practitioner's instrument of entitlement, with the presumption that a patient is not necessarily entitled to information that will help him make a decision but that the patient is obliged to accept the same information as justification for having been prevented from making the same decision. At minimum, Widener has been on the receiving end of a profoundly arrogant insult. Fortunately, not providing teaching-hospital information to Widener did not of itself have an effect on the outcome of the operation. But failing to provide such information at the moment of decision created a crisis of public relations, at minimum. And had the operation not been successful, the hospital's justification on the ground of its pedagogical structure would hardly have been used to strengthen its argument. Instead it would have pointed to the high qualifications and exp...