FREE ESSAY ON AN UPGRADE IN ETHICS

AN UPGRADE IN ETHICS

An ethics Upgrade 
By 
Ben Fehsenfeld
HCM381
Spring 2000
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.