How ethical is your organization? What are factors that affect its ethicalness? What should you do when faced with an organizational or an administrative ethical dilemma? The authors in this issue of OJIN explore different aspects of these questions through discussion of such topics as the changing health care environment, organizational culture, ethical theories and principles, professional codes, and exploration of real life administrative ethical dilemmas.
The first article, written by Silva, lays the foundation for the remaining four articles. She highlights how the restructuring of health care has precipitated challenging "new" ethical dilemmas for administrators and health care providers. She then focuses on the relationship between organizational culture and ethics and on how the building of a strong ethics infrastructure is essential to an ethical organization. Silva concludes the article with a true story of how one ethically committed nurse administrator was able to change a morally tainted organization into a morally responsible one.
In the second article, Badzek, Mitchell, Marra and Bower focus on an administrative ethical issue that has become increasingly problematic in our technological age '” the issue of confidentiality and privacy. They note that administrative ethical issues, including those of confidentiality and privacy, are often embedded in everyday practice and that these issues need to be identified and discussed. They also discuss the nature of confidential information, conflicts between law and ethics related to confidential information, and circumstances under which it may be morally justified to override confidentiality. The authors then present and systematically analyze a detailed case study that involves strong differences of opinions about confidentiality and about a nurse's diversion of narcotics for her own use.
The third article by Fletcher, Sorrell, and Silva focuses on the authors' premise that whistleblowing is a failure of organizational ethics. To sustain their premise, the authors first discuss background information about whistleblowing, the whistleblower, and morally justified reasons for blowing the whistle. This background information is discussed within the context of a nurse whistleblowing case that is presently receiving much professional and public attention. In reflecting upon the case and current professional codes and standards, the authors conclude that, in their current forms these documents do not provide adequate guidance related to whistleblowing. In addition, the authors make a plea that health care organizations go beyond mere compliance to a strong commitment that embraces an ethical climate that will eliminate the need for whistleblowing.
In the fourth article Aroskar moves away from the hospital setting of the preceding two articles and focuses on administrative ethics that have more of a community focus than an individual one. Using a community-based case study that focuses on an elderly and independent former teacher diagnosed with Alzheimer's Disease and one who is determined not to be placed in an assisted living facility, Aroskar carefully identifies the ethical concerns that the administrator, the case manager, and several other community members must face. Her ethical framework incorporates preventive ethics, as well as ethical theories, concepts and values pertinent to the case. One of her major points about the case and about community-based care is the tension that exists between respecting individual rights and respecting the rights of a community. Aroskar leads us to an "integrative" solution to the case that blends aspects of both of the preceding rights, as well as "drawing the line." She concludes her article with the thesis that the values and views of the community should inform ethical public policy.
Maddox, in the fifth and final article, focuses on administrative ethics and the allocation of scarce health care resources. She highlights how the restructuring of health care has altered mechanisms of accountability and how the rising cost of health care has forced rationing decisions. She then identifies six ethical principles of importance to health care leaders, but elaborates on the ethical principle of distributive justice which is the ethical principle most pertinent to the allocation of scarce resources. She concludes her article with a discussion of policy and management decision challenges related to scarce resources.
All of the preceding authors hope that one or more of the articles in this issue strikes a chord with you because of an organizational or administrative ethical issue in health care that you and/or a colleague have faced or are presently facing. We also hope that we have inspired you to help promote an ethical organizational culture wherever you work.
Article published December 31, 1998