Ethical-legal issues in a large inner city medical center or community hospital are not especially different from those in more affluent areas. But the clinical setting presents different dilemmas than the more abstract ones in the academic setting. Patients encountered in the inner city may be poor, of different ethnic origins and different belief systems or religions. Their needs all too often go unmet in a health care system that has some amazing successes and too often abysmal failures. If the three cases presented here seem to have concluded satisfactorily, it is only because of an unusual intervention and not a correction brought about by the system itself. The issues in each of these cases are quite common although how the situations played out were not.
1. Elderly woman stranded in a hospital for 6 months
2. Elderly nursing home patient repeatedly hospitalized with serious infections
3. Non–adherent AIDs patient, the mother of 4 children fathered by 3 different men

Alice Herb, J.D., L.L.M.

State University of New York, Downstate Medical Center

For the past thirteen years, Alice Herb has been Assistant Clinical Professor of Family Practice and Associate at Law, Division of Humanities in Medicine at State University of New York, Downstate Medical Center. In addition, she has been a visiting professor at Sarah Lawrence College since 1996. Prior to her current role as attorney-ethicist, Herb was a producer, director, and writer for ABC News as well as independent news and cultural affairs cable programs from 1966 through 1988. After receiving her J.D. from NYU School of Law in 1955, she practiced law for eleven years.

Herb serves on a wide variety of ethics committees and is a member of the New York State Bar Association, the American Society for Bioethics and Humanities, the American Society of Law, Medicine and Ethics, and The Hastings Center. Herb has authored numerous publications, including two articles which will be published this fall: Cochlear Implants in Children: Ethics, Informed Consent, and Parental Decision-Making, Journal of Clinical Ethics, co-authored with A. Berg and M. Hurst; Three Stubborn Misconceptions About the Authority of Health Care Agents, NYSBA’s Health Law Journal, co-authored with K. Burke and R. Swidler.