Medical Ethics Meets Organizational Ethics

When people think about health care ethics, they often imagine addressing clinical issues like end-of-life care or informed consent. While those issues remain central, for hospitals, health care ethics increasingly means organizational ethics, as well. Those two aspects of the field were addressed by Center Executive Director
Kirk O. Hanson and Director of Health Care and Biotech-nology Ethics Margaret R. McLean in keynote talks to a recent governance conference for the Daughters of Charity Health System (DCHS).

McLean set the stage for the discussion by talking about the core values of the Daughters system: respect, compassionate service, simplicity, advocacy for the poor, and inventiveness to infinity.

Focusing particularly on compassion, she asked, “What would it mean to be compassionate about the health and well-being of individuals and the community?” She then outlined a framework for ethical decision making in a clinical setting based on these core values.

Hanson followed with some guidelines on managing organizational ethics in a hospital. He looked at how values might affect organizational issues such as the treatment of employees, financial practices and reporting, purchasing practices, protection of patient and employee privacy, and social justice commitments.

To Hanson, “lessons learned about ethics by business organizations are now badly needed in the health care industry.” He discussed the way that hospitals can apply this learning in creating an ethical culture. Businesses, he explained, have approached ethics in three ways:

• Compliance
  
• Ethical exhortation
  
• Managing values

With a compliance approach, the organization establishes minimum standards of behavior and severe penalties for violations. In Hanson’s view, this approach is limited because it “may give the signal that the company wants only minimum ethical behavior.” It also may target lower level employees and give insufficient guidance for the really hard ethical decisions.

“Ethics exhortation,” another approach Hanson reviewed, includes training and frequent urging of employees to behave ethically. This, too, gives little help in complex ethical decisions, Hanson said, and “may imply that employees are to pay the short-term cost of acting ethically.”

Hanson favored what he called “managing values and integrity.” This approach defines and builds on the organization’s values—its aspirations—as well as identifying minimum ethical standards. Leaders who take this approach, Hanson said, “educate, model ethical behavior, and reward those who abide by organizational values and standards.”

The Markkula Center for Applied Ethics has a long history of involvement with the Daughters of Charity system. The Center has partnered with O’Connor Hospital in San Jose, a DCHS institution, for the past 12 years in creating the Applied Ethics Center at O’Connor, which McLean directs. In the past two years, two other DCHS hospitals, Seton Medical Center in Daly City and St. Louise Regional Hospital in Gilroy, have also partnered with the Center to heighten the awareness and improve the application of clinical and organizational ethics in those institutions.

February 2007