Organize the basic concepts, principles and information using the "four-topic" method to help distill the case down to its essence.
1. Introduction Identify and briefly define the major theme of the case (confidentiality and truthfulness, death and dying, maternal/fetal conflict or social justice)
2. Medical Indications should explore diagnosis, treatment goals, acute/chronic condition, possibilities of success, etc.
3. Patient Preferences should explore mental capacity, informed consent, advance directives, etc.
4. Quality of Life should elaborate on prospects for return to normal life, physical, mental, and social deficits, palliative care, etc.
5. Contextual Features should explore legal, cultural, religious, and familial issues).
6. Conclusion: Please include references from the readings, links, other literature and/or personal experience to support the answers to the questions posed in the case study and your final decision/solution to the dilemma.

A debate erupts when a Community Hospital located in a poor and indigent black neighborhood announces that as a cost-saving measure, it will close its emergency department from 10:00 pm until 6:00 am.
The hospital explains that it is in danger of going bankrupt, and its emergency department is a very expensive hospital department.
Patients will still be able to receive emergency treatment at a State Hospital, seven miles away.
Opponents argue that this will severely restrict indigent patients’ access to care.
Granted that the Community Hospital is in danger of going bankrupt, is its decision ethical?
Is the Community Hospital guilty of what is really a form of indirect “dumping” that is not covered by the law?
How will the access of indigent patients to health care at the State Hospital be limited?
Will the poor be unable to get there because they do not have cars and there is not public transportation?
Will the State Hospital’s emergency department be too small to handle the increased patient load?
Assuming that the answer to the last two questions is yes, what should the health care community have done to make the general community solve the problem?
Do health care professionals have an obligation to mobilize the community to remedy maldistribution?
What are the limits of that obligation?

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1. Introduction:
Federal and state laws mandate emergency care must be provided to every individual presenting at the emergency department (Bebber and Liberman, 2005) while there is no mandate which indicates the funding available to pay for this type of healthcare. As the number of individuals’ uninsured or underinsured escalates the increased burden upon the healthcare industry to obtain reimbursement from programs such as Medicare and Medicaid contributes to the growing frustrations of the emergency departments to remain viable. As a result these entities have resorted to a variety of avenues to meet the needs of the community to provide access to quality care....
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