Bioethicists have become very interested in the importance of social groups. This interest has spawned a growing literature on the role of the family and the place of culture in medical decisionmaking. These ethicists often argue that much of medical ethics suffers from the individualistic bias of the dominant culture and political tradition of the United States. As a result, the doctrine of informed consent has come under some scrutiny. It is believed that therein lies the source of the problem because the doctrine incorporates the assumptions of the larger society. Thus, informed consent has been reexamined, reinterpreted, and even abandoned as unworkable.

The 2010 Patient Protection and Affordable Care Act (ACA) requires not-for-profit hospitals, including Catholic hospitals, to engage in meaningful community assessment and collaboration efforts in order to maintain their tax-exempt status. Now that the ACA has been upheld by the U.S. Supreme Court, this paper argues that the requirements related to a more robust community engagement process should be embraced by Catholic not-for-profit hospitals and health systems. Apart from the legal requirements under ACA, an equally persuasive moral mandate to engage in community-level assessment and action exists in the ethical tradition of Catholic health care, particularly in the notions of the common good, preferential option for the poor, and subsidiarity. This paper examines the compelling nature of these moral norms in light of the dual goals of improving overall community health and reducing health disparities among vulnerable populations. It concludes with the examination of one model of community collaboration: Mobilizing for Action through Planning and Partnerships (MAPP).

Consider three scenarios: 1. St. Kevin's hospital had discontinued outpatient chemotherapy services several years earlier when the majority of this business moved to physician offices. Favorable Medicare reimbursement made this a profitable sector for oncologists and several opened or expanded infusion centers in their office practices. Recent changes in the Medicare program regarding reimbursement for chemotherapy and other oncology drugs has now led to physicians losing money on these same services. The local oncologists are now sending patients to St. Kevin's to receive these needed services. However, this service is unprofitable for the hospital as well. Hospital pharmacy costs are increasing and the outpatient department would need to add and train additional staff to provide this service. Some in hospital administration feel the hospital should simply not offer this money-losing service; others believe the hospital has an obligation to cancer patients to provide the service since it is needed in the community. Dr. Jones, an oncologist and member of the St. Kevin's ethics committee brings up the question during a regular ethics committee meeting. He asks: "Do you know administration is considering ending outpatient chemotherapy service?" He states emphatically that "the hospital ethics committee should be involved in these deliberations."2. Like every other business, Midwest County Regional Health Center finds that its healthcare costs are rising at an exponential rate. A twenty percent rate hike for employees is necessary to meet additional insurance costs. A concern is raised that this will make health insurance too expensive for entry level employees in the housekeeping and dietary departments leading to them dropping the insurance with the predictable decrease in their health status. A suggestion is offered that a sliding scale be put into place

A 24-year-old Hispanic male came into the emergency room of a large public teaching hospital with acute cardiac failure and chest pain. He was admitted and diagnosed with rheumatic heart disease and regurgitation and stenosis of both mitral and aortic valves. Medical judgment concluded that the patient needed to be medically stabilized and then undergo cardiac surgery to repair heart valves. The patient spoke only Spanish. Investigation through an interpreter revealed that he was an illegal alien from a Central American country who has lived in this country for five to seven years. He came to the United States so that he could receive treatment for his heart condition, evidently fearing that he would not receive treatment in his home country. The patient entered this country through the assistance of some distant relatives. He did not have a strong support system.

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