6 - Organizational Ethics

6.
Organizational Ethics
1
Organizational ethics
 An organization is a subunit of the larger society,
comprising individuals in various roles and authorized
by the larger society to function for specific, often
narrowly defined, purposes
 Organizations, as a whole, have larger purposes that
they serve in society (mission), the foremost of which
should be to provide health care to individuals and
populations in the case of health care organizations
 Organizations may have their own cultures that guide
how well they adhere to their mission and values in their
decision-making and behavior
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Organizational ethics…
 The mission and culture of organizations are the focus of
organizational ethics
 Organizational ethics is the study of how personal moral norms
apply to the activities and goals of an organization
 Organizational ethics is primarily concerned with the decision
making of organizations and managers
 An organization's ethics are the values, beliefs, and moral rules
that its managers and employees should use to analyze or
interpret a situation and then decide what is the “right” or
appropriate way to behave to solve an ethical dilemma
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 organizational ethics is the study and practice of the
ethical behavior of organizations
 Health care organizations that provide specialized care
for specific patient populations – make daily decisions
about resource allocation, clinical priorities, conflicting
interests, and community responsibilities, all of which
have ethical implications
 the organization as health care provider assumes
ethical rights and responsibilities distinct from those of
individual health care professionals
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 of central importance in distinguishing clinical from
organizational ethics is the notion of moral agency
 traditionally, bioethics has examined the actions of
individual agents - clinicians, patients, and family members
- and held them accountable in light of ethical principles,
norms, and obligations
 moral agency differs from that of clinical ethics and the
organization itself is seen as having obligations to adhere to
certain norms of ethical behavior
 an organization, like an individual, is a moral agent that can
be praised, blamed, credited, or held morally accountable
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 Rather than informed consent, confidentiality, patient autonomy,
decisional capacity, and end of life care:
 organizational ethics addresses the ethical dimensions of

decisions affecting groups of patients, as well as non-patient
related issues such as human resource issues, policies and
processes, and resource allocation decisions
 include conflicts of interest and obligation, marketing

practices, competition with other organizations,
responsibilities to the community, staff loyalty, physician
retention, reimbursement, and regulatory compliance
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 Bioethics was long focused on ethical issues arising in the
relationships and interactions of individual patients and their
physicians, as well as individual investigators and their research
subjects
 its focus on the ethics of professions, does not address the
organizational climate that promotes or impedes the ethical
delivery of health care
 what distinguishes organizational ethics is the notion that
organizations are more than aggregates of individuals with their
own roles and responsibilities
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 Health care organizations should be expected to develop a
sense of what is morally acceptable and unacceptable practice
and to manifest that sense in their policies and procedures
 It involves clarifying and evaluating the values embedded in
organizational policies and practices, and seeking
mechanisms for establishing morally acceptable values-based
practices and policies
 decisions must be grounded in or consistent with the ethical
principles and values that inform the organizational mission
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 organizational ethics can be defined as the intentional
use of values to guide the decisions of the organization
 What an organization does tells us what its values are
 organizations should see ethics as an indispensable
resource in organizational planning and decision making
 Ethics must begin at the top of an organization. It is a
leadership issue and the chief executive must set the
example --- Edward Hennessey.
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 Questions about resource allocation are among the most common
and important in organizational ethics
 When resources are scarce, an ethical approach to priority
setting seeks a fair distribution of available resources among
competing health needs
 How much priority ought to be given to population health
needs versus individual patient needs
 How much priority should be given to disease prevention as
opposed to treatment?
 In public health crisis, like influenza pandemic, who should
have priority access to vaccines, drugs, & hospital services?
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 Allocation decisions are trade-offs, necessitated by the fact
that health care resources and the economic assets needed
for their provision are limited
 Sometimes the trade-offs involve hard choices between
doing things that would improve the health of a
population in serious need and
 doing what is necessary to preserve the fiscal integrity
of the organization and, thereby, its long-term ability to
continue serving the needs of the community
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 the trade-off is not between some needed program and
institutional survival, but between a new program and
those that are already in place meeting other needs
 Resource allocation decisions often have to balance and
rank a number of competing considerations
 when budgets are limited, resources devoted to very
costly cutting-edge treatments and technologies that
might benefit a few patients diminish what is available
for less expensive care that can benefit a larger number
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 the central questions are: Who wins? Who loses? What
alternatives do the losers have for getting their needs met?
 Because resource allocation decisions confer benefits on some
(the winners) at the cost of not conferring benefits on others (the
losers), they raise issues of distributive justice (fair outcome)
 The distribution of the benefits and burdens inherent in resource
allocation decisions should be done in a way that is fair to all
concerned and does not discriminate against any group or
individuals
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Other ethical issues of health organizations include
 Partnerships and philanthropic fundraising
 In the face of scarce resources, are there restrictions on the
kinds of funding sources from which a health institution may
accept support?
 What if there is a conflict of interest between the values of
the potential funder and the health institution?
 Equitable access
 What obligations do health institutions or systems have to
care for the uninsured, patients beyond their catchment area
or jurisdictional borders, or future patients?
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 Workplace ethics
 What obligations do health institutions have to their staff to
ensure that the workplace is safe, respectful, and just?
 What supports ought to be in place to assist staff at all levels
in dealing with ethical issues in their daily practice?
 Public accountability
 What obligations do health institutions and systems have to
the communities they serve to be transparent about how health
resources are used and to reflect community values in their
decisions?
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6.

 organizational ethics addresses the ethical dimensions of

 include conflicts of interest and obligation, marketing

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