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.