Because hospitals are both health care providers and employers, they face significant challenges and remarkable opportunities, particularly to improve quality, increase access, and reduce cost, as implementation of the Affordable Care Act moves forward over the next several years.

Some intuitive normative principles raise vexing ‘detaching problems’ by their failure to license modus ponens. I examine three such principles (a self-reliance principle and two different instrumental principles) and recent stategies employed to resolve their detaching problems. I show that solving these problems necessitates postulating an indefinitely large number of senses for ‘ought’. The ...