What was the original purpose for hospitals, why did they expand and subsequently downsize within the U.S. health care system?

Reading for discussion 1

Wahi, M. (2013, May 26). U.S. health care: Hospitals Part 1. [Video File] Retrieved from https://www.youtube.com/watch?v=ZlWKN_mfpUc   (1:15:02) Focus is on the first 35 minutes of the lesson.

Wahi, M. U.S. (2013, May 26). U.S. health care: Providers and professionals. [Video File] Retrieved from https://www.youtube.com/watch?v=j4ZDSuNaMmg (28:52)

Discussion 1

What was the original purpose for hospitals, why did they expand and subsequently downsize within the U.S. health care system?

Cite your source(s) and respond to the response below.

In the United States, cities established isolation hospitals in the mid 1700s, and almshouses devoted to the sick or infirm came into being in larger towns. However, almshouses were not intended to serve strictly medical cases since they also provided custodial care to the poor and destitute. Benjamin Franklin was instrumental in the founding of Pennsylvania Hospital in 1751, the nation’s first such institution to treat medical conditions. Physicians also provided the impulse for the establishment of early hospitals as a means of providing medical education and as a source of prestige. For most of the nineteenth century, however, only the socially marginal, poor, or isolated received medical care in institutions in the United States. When middle- or upper-class persons fell ill, their families nursed them at home. Even surgery was routinely performed in patient’s homes.

Between 1865 and 1925 in all regions of the United States, hospitals transformed into expensive, modern hospitals of science and technology. They served increasing numbers of paying middle-class patients. In the process, they experienced increased financial pressures and competition. 

According to an article by Bazzoli, between 1980 and 1995, hospital inpatient admissions declined by approximately 15 percent, and occupancy rates nationwide fell from about 76 to 63 percent. If a hospital believes that it does not have optimal capacity, it is likely to adjust its supply of services. Maintaining too much capacity can entail costs that may not be compensated by existing payment methods and thus may detract from a hospital’s viability.


Bazzoli, G. J., Brewster, L. R., May, J. H., & Kuo, S. (2006). The transition from excess capacity to strained capacity in U.S. hospitals. The Milbank quarterly84(2), 273–304. https://doi.org/10.1111/j.1468-0009.2006.00448.x

History of Hospitals. History of Hospitals •  Nursing, History, and Health Care • Penn Nursing (upenn.edu)

Reading for discussion 2

American Academy of Hospice and Palliative Medicine. [AAHPM]. (2014, December 5). Statement on Palliative Sedation.  Retrieved from http://aahpm.org/positions/palliative-sedation

Anderson, R. T. (2015, April 20). Physician-Assisted Suicide Corrupts the Practice of Medicine. Health care, 4391. Retrieved from http://www.heritage.org/research/reports/2015/04/physician-assisted-suicide-corrupts-the-practice-of-medicine

Palliative Care- Stanford School of Medicine. (2017). Retrieved from https://palliative.stanford.edu/palliative-sedation/definition-and-epidemiology/

Discussion 2

In 200-300 words.  What is palliative sedation? What is the difference between physician-assisted suicide and end of life palliative sedation? Please explain the difference in terms of ethics and the literal meaning.

Cite your source(s) and respond to the response below in 200-300 words.

When talking about palliative sedation, a doctor gives a terminally ill patient a good amount of sedatives to induce cognitive state (Statement on Palliative Sedation”, 2014). The ultimate end goal is to go back or get rid of suffering, however in plenty of instances the patient dies without their consciousness restored (Cherny, n.d.).

There will regularly be uncertainty regarding the putting to death (euthanasia), palliative sedation, and assisted suicide. Putting to death isn’t legal within the United States of America, this is often by design ending the lifetime of a patient sometimes done by injecting a substance into a patient when they are seeking to terminate his or her own life (Ollove, 2018).  Assisted suicide is legal in particular states in the United States and shows a patient ending his or her own life sometimes with a prescription from a physician, but the patient truly takes his or her own life. Palliative sedation is medication given proportionately to severe pain and suffering at the tip of life, that makes a patient unaware.

The key ethical identifying factors that set palliative sedation except for each assisted suicide and euthanasia are intent. Proportion can also be considered. Palliative sedation is finished to make the patient experience as pain-free as possible (Olsen et al., 2010). The medications needed to the present this render an individual unconscious. this is often proportion. Enough medication is given in proportion to the pain the patient is experiencing.

the opposite identifying issue is intent. Palliative sedation lacks the intent to evoke a patient’s death. However, putting to death and assisted suicide (while with reasoning to finish the nice suffering of the terminally ill) every have the intent to evoke the death of the patient.


Statement on Palliative Sedation. (2014). AAPHM. http://aahpm.org/positions/palliative-sedation

Cherny, N. C. (n.d.). Palliative sedation. Up To Date. Retrieved May 21, 2021, from https://www.uptodate.com/contents/palliative-sedation#H21552026

Olllove, M. O. (2018). Palliative Sedation, an End-of-Life Practice That Is Legal Everywhere. PEW. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/07/02/palliative-sedation-an-endoflife-practice-that-is-legal-everywhere

Olsen, M. L., Swetz, K. M., & Mueller, P. S. (2010). Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clinic proceedings, 85(10), 949–954. https://doi.org/10.4065/mcp.2010.0201