Despite the bioethics explosion little attention has been paid to the ethical roles and responsibilities of those who are ultimately in charge of hospital governance. Traditional legal frameworks and paradigmatic understandings of the role of trustees no longer suffice as guides to ethical responsible accountability and conduct. The goal of this book is to show that the decisions made by hospital trustees and the actions of hospital boards do raise important ethical issues, and that ethical dimensions of trustee service should be more explicitly recognized and discussed. The essays included here are based on a Hastings Center research project involving extensive interviews and group meetings with 98 nonprofit hospital trustees and CEOs over a two-year period. What emerged from these interactions were four principles of hospital trusteeship: 1. Fidelity to mission; 2. Service to patients; 3. Service to the community; 4. Institutional stewardship. These principles guide the thinking of the contributors, and represent the book's scholarly contribution to the field. The first part of the book offers a philosophical and theoretical framework for understanding the four principles; the second part of the book is more practical, offering readers empirical data on how hospital trustees actually perform--and should perform--their duties. These latter chapters address such issues as money and mission, religious issues in Catholic hospitals, the role of ethics committees, and patient safety.