The resurgence of ethics has been a striking phenomenon in the past decade. Although ethics has always had a role in the healthcare field, only in recent years has it become a subject of intense interest and controversy. In addition to others, this interest has affected a variety of other fields as well, in particular, philosophy, religion, social sciences, and law. Ethics are more than just high quality morals. Using ethical knowledge, attitude, skills, and habits require intellect, and finesse to properly apply them in the professional organizational life. Reasons for increased societal focus on ethics in organizations are many. Insider trading on Wall Street; defense contract scandals, involving private and public sectors; rental car repair overcharges; and resignation of over 100 Reagan administration officials have helped to keep ethical issues in the public eye. What I want to do in this presentation to give you all some valuable information to stimulate your own ethical aspects that you may already have and to upgrade your present ethical intentions.
The problem that I would like to focus on here is the current ethical dimension that seems to be present in most of the professional organizations. It seems to me that there are those health care managers that do not even want to think ethically or that they just have a greedy streak that runs through them. Alternatively, there are those that just have a low ethical intensity. To me this reminds me of an issue-contingency matter where there is simply a lack of information on ethical aspects being flowed in their direction. On the other hand, they are simply ignoring, as if wearing blinders, the high standards that they now need to implement into their professional life. Ignoring ethical thinking will only hurt you or your company in the end. If you or someone you know is found to have been unethical in the past, the way people remember that inadequacy- just because it was unethical, it’s almost like they are criminals or pure violators. They seem like violators to their peers simply because the standards and the criteria of ethics are being upgraded in society.
Healthcare professionals exercise considerable influence and power over the lives of patients, subordinates, and colleagues- often in routine and subtle ways. Executives can set the schedule that favors some and not others … double-check procedures or not check them at all… emphasize harmony in the office or tolerate impersonal squabbles … pass on training information or forget to do so… greet patients with honor and respect or hardly acknowledge them … intimidate subordinates or encourage them. Because such routine actions are a daily part of healthcare delivery, the ethical dimension of ordinary professional life must be explored. Healthcare ethics must probe the ethical significance of seemingly inconsequential situations and help healthcare professionals use their power responsibly within the contexts of their daily tasks. (5)
The abuse of power is just as prevalent in healthcare organizations as mush as in other types of organizations. Patients and their families are exceptionally vulnerable in a time of crisis. They are apprehensive, sometimes frightened, and often intimidated by the organization’s sheer physical size and bureaucratic complexity. Similar problems can occur when managers who have significant authority do not use it for the good of the organization and those it serves. Employees under their supervision can be compromised by their misuse of power, adversely affecting both morale and productivity. Like patients and their families, employees may feel helpless and hesitant to object to such behavior. Examples of abuse of power include rudeness, profane language, promise breaking, deception, dishonesty, and sexual harassment. Less obvious forms of abuse of power tend to be subtle and therefore more insidious; these include arrogance, use of overly confusing jargon, and withholding of information. (3)
Management and medical staff sometimes rationalize this sort of unprofessional conduct because they view it as unintentional and non-malicious. However, in addition to compromising its immediate victims, tolerating such behavior has several negative long- term consequences, such as encouraging the individual to continue this conduct, silently condoning the behavior and suggesting to others that they can behave in a similar manner with impunity demoralizing those who become aware of the organizations’ tolerance, and adversely affecting the image and reputation of the organization.
Power. The actual influence, or power, that healthcare professionals have in their position is an important reality. Because the actions of a healthcare executive affect other people, they must see clearly the influence of power that they exercise and monitor the effect it has on patients, subordinates, and peers. Most of this influence is more subtle and difficult to recognize than the “official” power of the position.
Control. It is a fact that mechanisms of control permeate the environment of healthcare-mechanisms designed to direct the power of healthcare professionals toward values such as fairness, clinical competence, economic efficiency, and human dignity. Some of these controls are “formal” such as codes of conduct, JCAHO standards, hierarchical supervision, and operational procedures. Others are “informal” such as peer pressure, corporate norms, and prevailing attitudes. Awareness of how these controls affect us in our everyday work is essential to understanding the ethics of our routine behavior.
Values. The third aspect of healthcare ethics involves questions over conflicting expectations or values. As healthcare professionals we are expected to use the power we exercise in a way that supports the fundamental values of the healthcare field, such as patient wellbeing, economic efficiency, and legality. These expectations or values are guides to the ethical use of power. Unless we see and understand them clearly, we are apt to use our power in ways that support some values but undermine others. For example, scheduling patient in way that that results in long delays may maximize economic efficiency but minimize respect for patient dignity. These three key and essential realities of the ethical dimension of healthcare are depicted in the reality prism. Three sides but one prism. The clarity needed to enable informed decision making is not achieved if one side of the prism is cloudy. Also, notice that the three sides interact with each other.