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
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
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:
- Ethical exhortation
- Managing values
With a compliance approach, the organization establishes minimum
standards of behavior and severe penalties for violations. In
Hansons 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 organizations
valuesits aspirationsas 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 OConnor Hospital in San Jose, a DCHS
institution, for the past 12 years in creating the Applied Ethics
Center at OConnor, 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.