Business Ethics in Healthcare: Beyond Compliance

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 in clinical ethics, but are not well prepared to address issues in business or management ethics. The Clinical Ethics Committee, when it performs well, already has a full agenda, probably too full to allow the necessary time and energy to develop a whole new competence. An alternative to adding additional responsibility to an existing committee is to establish what is often called the Organizational Ethics Committee. This chapter is a discussion of the functions, responsibilities, and membership quali¤cations of the Organizational Ethics Committee (OEC). Though the OEC is an alternative to adding major additional responsibilities to the existing Ethics Committee, the OEC follows the model of the Clinical Ethics Committee in many ways. It is designed to give the same sort of attention to practical ethics in management as a good Clinical Ethics Committee gives to practical issues in patient care. Committee Functions and Membership A good Organizational Ethics Committee is designed to assist managers in their efforts to make decisions that re®ect the highest ethical standards of the healthcare business. The committee’s agenda is to promote the achievement of Eighteen The Organizational Ethics Committee these standards in all areas of management. It is an advisory committee, not an enforcement committee. Like the Clinical Ethics Committee, the OEC can identify its functions as three: education, policy development and review, and case consultation. Among the charge of the OEC are the following: 1. to develop and/or review policies and procedures related to ethically sensitive organizational issues; 2. to serve as a consultative body (or arrange for consultation by others) for discussion of and recommendations on ethically sensitive issues facing management; 3. to provide educational opportunities for consideration of speci¤c ethical issues and for insight into the evolving understanding of healthcare business ethics. There is at least one signi¤cant way in which the consultative function in business ethics is signi¤cantly different from that function in clinical issues. Clinical Ethics Committees usually do not report to the clinicians to whom they may make recommendations. Rarely is one of the parties involved in a particular case that comes before the committee also responsible for overseeing the work of the committee. In the work of the OEC, on the other hand, organizational leaders are likely to be those to whom the committee reports as well as those to whom consultation is provided.1 Given the realities of life in organizations, it may not be reasonable to expect that candid and potentially unwelcome suggestions will be given to those who are higher in the organizational hierarchy. The independence of those doing business ethics consulting needs to be ensured if the committee is going to be effective and credible. Clinical Ethics Committees are interdisciplinary committees, with membership that includes physicians, nurses, social workers, and chaplains. Often administration and risk management are represented as well. Many such committees include a community representative or two. Quite often, Ethics Committees have an established relationship with an outside ethicist, who serves as a member of the committee or as a consultant to the committee. The OEC is also best structured as an interdisciplinary group, but with a somewhat different mix. Key constituencies to be represented in membership of the OEC include management, non-management employees, clinical staff, and an ethicist. Management Just as the majority of members of the Clinical Ethics Committee are usually from the clinical care areas, so the majority of members of the committee that addresses issues related to management ethics should be persons in manageInstitutionalizing Business and Management Ethics 172 ment positions. Though an argument can be made for having representation from some speci¤c departments (such as Human Resources), having the right persons on the committee is more important than representation of speci¤c management functions. What is needed is a core of management-level employees who are or can become skilled in healthcare management ethics and who are able to apply these skills to a variety of situations. What is needed is a group of managers who have the independence and integrity to put commitment to...