Ethical issue experience – 350 words

Healthcare Management Ethics

No one would deny clinical and
administrative healthcare profession-
als regularly encounter ethical chal-
lenges. For clinicians, the challenges
may relate to a conflict regarding
withholding or withdrawing life-
sustaining interventions or breaching
patient confidentiality. For the execu-
tive, the conflict may involve a deci-
sion concerning a needed service that
is a financial drain on the organiza-
tion or the abusive behavior of a
highly productive administrator.

Ethical conflicts are best
addressed when all the
people who are legitimately
involved have an
opportunity to discuss their
values, perceptions and
concerns in an open and
respectful environment.

What is the same for clinician and
executive decision makers is the
potential for an ethical conflict or
controversy. All ethical conflicts are
characterized by a number of com-
mon components. An ethical conflict
occurs when an uncertainty, a ques-
tion or a controversy arises regarding

competing ethical principles, per-
sonal values, or organizational and
professional ethical standards of
practice. Examples of such standards
include the American College of
Physicians’ Ethics Manual or the
American College of Healthcare
Executives’ Code of Ethics.

Once an ethical conf lict is identi-
fied, the challenge becomes how
healthcare leaders and other staff
involved in the situation should
respond. The use of a systematic
process can enhance the analysis
leading to a response that is ethi-
cally justifiable. For the clinician,
executive or ethics committee mem-
ber, applying a systematic process
can diminish the possibility of
making quick decisions lacking
thoughtful ref lection and sound
ethical reasoning.

The Importance of a Standard
Process for Resolution
A little over a decade ago, I was
changing positions. Because I
talked frequently about the impor-
tance of systematic ethical reason-
ing, during a farewell gathering, I
was given a small poster that hangs
in my office today. It reads, “Ethics,
schemethics; f lip the damn coin.”
The cynicism serves as a constant
reminder of the need for the

opposite—to always apply a care-
fully developed process to address
ethics conf licts. The process will
take time and effort, yet it can lead
to ethically defensible decisions
rather than convey the general atti-
tude, “Because I said so.” The pro-
cess can foster a focused application
of ethical principles, institutional
values and policies to ethical con-
f licts. It promotes thoughtful and,
hopefully, respectful dialogue
between the parties involved in the
ethical conf lict.

Unlike some decision-making mod-
els, the application of a uniform sys-
tematic process for addressing both
clinical and administrative issues is a
subtle-but-important distinction. It
emphasizes that a process should not
be based on such