Business Ethics in Healthcare
Publication Year: 2001
Healthcare ethics is not just about decisions made at the bedside. It is also about decisions made in executive offices and in boardrooms. Business Ethics in Healthcare offers perspectives that can assist healthcare managers achieve the highest ethical standards as they face their roles as healthcare providers, employers, and community service organizations. Weber suggests guidelines and criteria based on the understanding that the healthcare organization is committed to patients' rights, to careful stewardship of resources, to just working conditions for employees, and to service to the community.
As Weber shows, addressing business ethics issues in a healthcare organization starts with complying with relevant laws and regulations. As a provider of high quality patient care with limited resources, it needs to be able to distinguish between the right way and the wrong way of taking cost into consideration when making decisions about patient care practices. As employer, the organization needs to use good criteria for determining wages and salaries, to know how to make fair decisions about downsizing, and to respond most appropriately to union organizing efforts and employee strikes. As a community service organization, it has particular responsibilities to the community in the way it advertises, how it disposes of medical waste, and the types of mergers it enters into.
Leonard J. Weber is on the faculty of the University of Detroit, Mercy. He has published over 70 articles and is the principal author of the "Case Studies in Ethics" column in Clinical Leadership & Management Review. He serves as an ethics consultant to several healthcare organizations and is a past president of the Medical Ethics Resource Network of Michigan.
Medical Ethics Series -- David H. Smith and Robert M. Veatch, editors
Published by: Indiana University Press
Series: Medical Ethics
Title Page, Copyright, Dedication
The preparation of this book was supported in part by a grant from the Myrtle E. and William G. Hess Charitable Trust. I want to express my appreciation as well for the opportunity provided by the University of Detroit Mercy to use a major portion of my time and energy over the years in working with healthcare organizations on practical ethical ...
Introduction: Beyond Compliance, Beyond Integrity, Beyond Clinical Ethics
Healthcare business ethics is, in many ways, the meeting of medical ethics and business ethics. There has been much interest in medical ethics in the United States during the last three decades, an interest much more focused on patient care issues and on medical research than on the management of healthcare organizations. The interest in business ethics is also very strong. ...
Part I: Business Ethics With A Difference
One: Healthcare Business Ethics
... Board meeting of the managed care plan. The next year’s budget was being presented for Board approval and the CFO was explaining some of the assumptions on which the projections were based. One expectation was that the organization would be successful in lowering the “medical loss ratio” by more than one full percent from the current number. ...
Two: Ethics Is Not Neutral: A Framework for Making Decisions
There are two kinds of ethics concerns that need to be addressed in any organization. And management, accordingly, has two kinds of ethics-related responsibility. One concern relates to adherence to ethical standards. Management has a responsibility to ensure that established ethical standards are known and observed, ...
Part II. The Organization As Caregiver
Three: Ethics, Cost, and the Quality of Care
In an essay entitled “Redrawing the Ethics Map,”1 Richard Lamm argues that medical ethics, “as it is usually understood,” is completely inadequate when it comes to the funding of medical care. Medical ethics needs to be revised because of its reluctance to take cost into account and because it tends to focus on only one patient at a time. Neither tendency is satisfactory, he argues, ...
Four: Patient Rights in a Just Organization
Respecting the rights of individual patients is a characteristic of an ethical healthcare organization. It is not the only characteristic, however. There is a need to understand clearly the ways in which respect for patient rights relates to a variety of ethical responsibilities. Medical ethicists have been engaged in ongoing reflections on the nature and limits of patient rights. Concern that patients are sometimes subjected to ...
Five: Clinicians and Conflicts of Interest: A Focus on Management
In their role as caregiver, healthcare organizations employ clinical professionals or enter into other contractual working relationships with them. Management decisions may have an impact on the ability of clinicians to act in the patients’ best interests and on the likelihood that they will do so. The purpose of this chapter is to consider some management decisions and policies that ...
Six: A Fair Hearing of Appeals of Denied Coverage in Managed Care Plans
Managed care has grown rapidly in the United States during the last decade and has, in recent years, been subjected to widespread criticism. Much of the criticism is directed at practices that are perceived as denying patients needed care. One issue related to that concern, tying physician compensation to resource use, is discussed in Chapter 5. This chapter is related to another aspect ...
Seven: Organizational Ethics: A Code Is Only the Beginning
In 1995 the Joint Commission on the Accreditation of Health Care Organizations began to include accreditation standards related to organizational ethics. These standards now require a code of ethical behavior that addresses, at a minimum, marketing, admission, transfer and discharge, billing, and the relationship of the organization and its staff to other providers, payers, and educational ...
Part III: The Organization As Employer
Eight: Just Wages and Salaries
It hardly needs to be said that wages and salaries are of great importance when considering ethical issues in any organization. Though there are many reasons for working in addition to the money earned for the job, the level of pay is very important for employees throughout the organization. Responses to the question of whether employees are treated fairly usually begin with a ...
Nine: Ethics and Downsizing
The announcement informing employees that layoffs will occur is one of the most difficult memos the CEO can write. The news that layoffs will occur is among the most dispiriting pieces of news that employees can hear. Downsizing is an extremely difficult situation for all involved. The way in which downsizing-related issues a re handled has an impact on the workplace that ...
Ten: Patient Requests for Healthcare Providers of a Specific Race or Sex
One of the characteristics of an ethical manager in American society today is informed sensitivity to the ways in which attitudes toward persons of a different race, sex, nationality, culture, religion, or social/economic position can affect behavior. Chapter 7 included a brief discussion of the potential impact of these attitudes on the quality of healthcare. There the focus was on the importance of ...
Eleven: Conscientious Objection to Participation in Certain Treatment Options
It is a not always easy to know when members of the professional staff should be exempted from particular patient care situations for reasons of personal conscience. Acceptance of the conscientious beliefs of individuals is an essential part of any society or any organization committed to respecting individuals in their differences. On the other hand, those seeking professional services ...
Twelve: Union Organizing and Employee Strikes
Chapter 9 included Frank Narvan’s observation that decisions related to downsizing strategy “become the model. They tell all employees what the new rules are. These decisions set the standard for the ethics of future decisions.”1 How downsizing is handled is one of those defining moments, a loud and clear communication regarding the values that management actually adheres to in ...
Part IV: The Organization As Citizen
Thirteen: Responsible Advertising
Advertising has long been recognized as a major tool in efforts to achieve business success. It has long been understood, at the same time, to be an ethically risky business tool. Education in the essentials of business ethics has always included consideration of the ways in which advertising can take unfair advantage of potential consumers or cause other harm. In its initial emphasis ...
Fourteen: Environmental Responsibility and the Precautionary Principle
The hospital CEO has called a meeting of the management team to decide what to do in response to an outside group, made up of environmental activists and others, that is claiming that the hospital is contributing to environmental health problems. The group, in a campaign called “Health Care Without Harm,” argues that the incineration of medical waste is a leading source of dioxin ...
Fifteen: Community Serving Mergers and Acquisitions
Even the most casual observer of the healthcare industry is well aware that the last decade has been a time of restructuring in healthcare organizations. Acquisitions and mergers are common. Mergers and acquisitions are more than new organizational arrangements; they are more than disruptive periods to be gotten through quickly in order ...
Sixteen: Socially Responsible Investing
In the final chapter of this section on the role of the healthcare organization as citizen, it may be useful to give some attention to the responsibility of the organization as investor. There are various other activities, such as purchasing, that also raise important questions related to the responsibilities of the organization. Responsible investing is, however, of special interest to a number ...
Part V: Institutionalizing Business And Management Ethics
Seventeen: Components of a Business Ethics Program
Formal ethics programs in healthcare settings can and do make a difference. As someone who has had the opportunity over the years to work with many different Ethics Committees, I have observed a significant impact in clinical ethics. The committees and the programs that they have sponsored have contributed to an increased sensitivity to ethical concerns and to an improving ...
Eighteen: The Organizational Ethics Committee
With the recent growth of interest in healthcare business ethics, some organizations have asked their existing Ethics Committee to enlarge its charge, to include issues in “organizational ethics” as well as issues in clinical ethics. This may work well in some cases, but is probably not the best approach in most situations. Most Ethics Committee members have developed some expertise ...