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The prospective payment system for the reimburse ment of hospitalizations has stimulated utilization re view and quality assurance activities. Patients are definitely being discharged more quickly, but the pri mary concern is that they would be discharged pre maturely. In either case increased posthospitalization support is required. This study reviewed the timeli ness of the request for the consultation with the dis charge planner, the timeliness of the process of relay ing the consultation to the discharge planner, and the timeliness of the response of the discharge planner to the consultation. The discharge planner was asked to see 35 of the 72 patients in this study during the first week of their hospitalizations. Of the 69 patients who were discharged, 33 were discharged either the same day of or the following day after the consultation request. Although several systems have been devised for early recognition of patients' needs for discharge planning, none would be necessary if physicians would identify appropriate patients early during their hospitalizations.

26:T496,

This article summarizes the convictions of a profes sional ethicist and director of a hospital-based bioeth ics institute with regard to decisions of clinical ethics, especially those surrounding care of the terminally ill.

An ethical and legal distinction is made between refusal of treatment on the one hand, and assisted suicide and euthanasia on the other. However, no ethical distinction is maintained between withholding treatment or withdrawing it when it seems inappro priate.

The importance of consent for all invasive medical treatment is emphasized, including all artificial deliv ery of nutrition and hydration. The rights of patients and legitimate proxies to refuse treatment on the basis of burdensomeness and uselessness are under scored.

The importance of palliative care is noted, brain death is considered, organ donation is encouraged, and the article ends with a reminder that life is a basic, but not absolute, value.

27:T65a,