Abstract

New York City Health + Hospitals (NYC H+H), our nation’s largest municipal healthcare system, with 10 acute care hospitals and five long-term care facilities, asserts in its mission statement that healthcare workers should join with communities to promote and protect the total physical, mental, and social well-being of the people. Such is reflective of the communitarian viewpoint, focusing on the importance of the community and advocating for their common good, which is in keeping with the concept of communitarian ethics espoused by Nancy Dubler when she assumed the role of ethics advisor to NYC H+H in 2009. From the onset she implemented key changes, beginning with the creation of a system-wide Bioethics Council, in which all 10 ethics committee chairpersons met regularly with her. During these meetings, groundwork was laid for (1) creation of standardized clinical ethics chart notes, with inclusion of key ethical principles; (2) establishment of a Clinical Ethics Consultation Program for continuous evaluation of performance and education of clinical ethics consultants; (3) development of mechanisms to qualify consultants, including a year-long bioethics certificate course, supervised training, and participation in an annual ethics symposium; (4) formation of clinical ethics algorithms; and (5) publication of journal articles to highlight the work of the Bioethics Council to the broader bioethics community. This article will focus on how Nancy transformed the nation’s largest municipal healthcare system from an enterprise lacking an integrated approach to clinical ethics to one with a robust clinical ethics infrastructure and vibrant ethics community.