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Nancy Berlinger, Ph.D

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Nancy Berlinger photoNancy Berlinger, a research scholar at The Hastings Center since 2002, studies ethical challenges arising in health care work, encompassing health care ethics, public policy concerning health care access, and problems of safety and harm in health care systems. 

Her first book, After Harm: Medical Error and the Ethics of Forgiveness(Johns Hopkins, 2005), explored how health care professionals and organizations respond in the aftermath of harmful medical mistakes, analyzing common problems and offering concrete recommendations to ensure better care for injured patients, their loved ones, and also for professionals themselves. Her most recent book, Are Workarounds Ethical?, expands this research by looking at shortcuts, fixes, bending the rules, and other everyday improvisations in health care work, the conditions that drive workers to devise workarounds, and the implications of these fast decisions and unofficial practices for patient safety and the health care work environment. The book reflects insights from recent social science research on how people make and act on moral judgments and on what makes processes of behavior change, including patient safety efforts, succeed or fail, and offers a set of recommendations for health care organizations. Selected publications: 

Are Workarounds Ethical? Managing Moral Problems in Health Care Systems(Oxford, 2016) 

“Ethics at the Chocolate Factory” (OUP blog, October 22, 2015) 

In health care ethics, her projects focus on decision-making and care concerning people with life-threatening or serious chronic conditions and on organizational and population health approaches to improving health care for people nearing the end of life. She led the multi-year research project supporting the revision of the landmark 1987 Hastings Center Guidelines on end-of-life care and is the first author of the revised and expanded second edition. She currently co-directs Guidelines implementation projects in collaboration with the Society of Hospital Medicine (SHM) and the American Association of Critical-Care Nurses (AACN). She is part of an international research team of scholars from The Hastings Center, the University of Oxford, and the National University of Singapore that has created the Singapore Casebook, an innovative web-based, public-access ethics education resource in wide use in the world’s fastest aging society.  Selected publications: 

N Berlinger, B Jennings, and SM Wolf, The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life: Revised and Expanded Second Edition(Oxford, 2013)  

SM Wolf, N Berlinger, and B Jennings, “40 Years of Work on End-of-Life Care – From Patients’ Rights to Systemic Reform,” NEJM 372; 7 (2015): 678-82  

N Berlinger, R Barfield, and AR Fleischman, Facing Persistent Challenges in Pediatric Decision-Making: New Hastings Center Guidelines,”Pediatrics 132:5 (2013): 789-91 

JJ Chin, N Berlinger, MC Dunn, CWL Ho, MK Gusmano, eds., Making Difficult Decisions with Patients and Families: A Singapore Casebook(National University of Singapore, 2014)  

J Moses, N Berlinger, MC Dunn, MK Gusmano, and JJ Chin, “Bioethics Casebook 2.0: Using Web-Based Design and Tools to Promote Ethical Reflection and Practice in Health Care,” Hastings Center Report 45, no. 6 (2015): 19-25

She co-directs the Undocumented Patients project, which explores professional and resource allocation challenges in providing health care to undocumented uninsured patients; the Undocumented Patients public website serves as a research and education hub for scholars, students, journalists, advocates, and policymakers. The project’s collaboration with the New York Immigration Coalition recently produced recommendations that informed the creation of a direct access health care program for undocumented uninsured residents of New York City, set to launch in 2016. Selected publications: 

N Berlinger, C Calhoon, MK Gusmano, and J Vimo, “Undocumented Patients and Access to Health Care in New York City: Identifying Fair, Effective, and Sustainable Local Policy Solutions: Report and Recommendations to the Office of the Mayor of New York City,” The Hastings Center and the New York Immigration Coalition, April 2015.   

N Berlinger and R Raghavan, “The Ethics of Advocacy for Undocumented Patients,” Hastings Center Report 43, no.1 (2013): 14-17. 

Her research is supported by the Milbank Foundation, the Lien Foundation, the Donaghue Foundation, and other funders. She has presented extensively throughout the U.S. and internationally. 

Current and recent public service related to her research includes: 

Bioethics Committee, White House Office of Science and Technology Policy Initiative on Cancer Diagnostics in Sub-Saharan Africa (2015 - ); Care and Coverage Subgroup, Mayor’s Task Force on Immigrant Health Access, City of New York  (2014 -15); Expert Panel on Palliative Care, American Heart Association/American Stroke Association (2013-15); Working Group, “Advance Decisions,” University of York/University of Cardiff, UK (2012-13); Sub-Working Group, National Vaccine Advisory Committee on Health Care Personnel Influenza Vaccination, US Department of HHS (2010 -12); ad hoc Evaluation Advisory Committee, Needs Assessment of NIH-Funded End of Life and Palliative Care Science, NINR (2010-12); Bioethics Committee, Montefiore Medical Center (2005 -  ). 

She is a graduate of Smith College (1984) and earned her doctorate in English Literature from the University of Glasgow (1988). She also received a MDiv, with a focus on ethics, from Union Theological Seminary (2002).