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Open Access Research article

An ethical framework for cardiac report cards: a qualitative study

Shawn A Richard1, Shail Rawal1 and Douglas K Martin12*

Author Affiliations

1 University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, Ontario, M5G, Canada 1L4

2 Department of Health Policy, Management and Evaluation, McMurrich Building, 2nd Floor, 12 Queen's Park Crescent West, Toronto, Ontario, M5S 1A8, Canada

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BMC Medical Ethics 2005, 6:3  doi:10.1186/1472-6939-6-3

Published: 28 March 2005



The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs.


Delphi technique – 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes.


We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement.


We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.