What is ethics and what place does it have in decision-making? Ethics means different things to each of us. We develop our ethics from our culture, ethnic background, religious beliefs and all that make us unique as humans. Knowing this does not help when we are asked as administrators or managers to make decisions that are jam-packed with ethical dilemmas. Acting as Faith Community Hospital (FCH) administrator I turned to the Santa Clara University website, article A Framework for Ethical Decision Making. This article gives five steps that I will use to address the problems FCH face. They are: Recognize a moral issue, Get the facts, Evaluate the alternative actions from various moral perspectives, Make a decision, Act, then reflect on the decision later.
Ethical Decision Making
Trying to determine the meaning of ethics is, to say the least, a challenge. My search for that meaning took me to the Santa Clara University website. There I found discussions that I agreed with. Sociologist Raymond Baumhart found that replies to the question What does ethics mean to you? was as diverse as those he asked. The answers varied from personal feelings to what is socially acceptable, from religion to legality.
So then, what does it mean to be ethical in your decision-making? Shanks tell us because we have the ability to be critical of our interpersonal behavior . . . . . we have the ability to develop codes and norms to guide that behavior. Those moral norms and codes, plus a set of virtuous character traits, are what we mean when we talk about ethics. He also tells us that while we all endeavor to make ethical decisions we run into stumbling blocks inhibiting our ethical decision-making. He lists the following:
-My small effort wont really make a difference
-People may think badly of me
-Its hard to know the right thing to do
-My pride gets in the way
-It may hurt my career
-It just went by too quickly
-Theres a cost to doing the right thing
Weve all had to face these stumbling blocks. This is why ethical decision-making is so personal and varied.
In our case study of Faith Community Hospital we came across many issues needing resolution. The majority if not all of them required ethical decision-making. Faith Community had a diverse group of employees, and each of them had their own set of ethical/moral standards. While administration can appreciate those differences, the responsibility to bring unity to the organization falls to them. Putting my self in the role of administrator, how do I accomplish this task? Again, I turn to the Santa Clara University website, to the article A Framework for Ethical Decision Making. This article gives five steps that I will use, they are:
1.Recognize a moral issue
2.Get the facts
3.Evaluate the alternative actions from various moral perspectives
4.Make a decision
5.Act, the reflect on the decision later
First, recognize a moral issue. At Faith Community there are several issues. They are:
-Staff on both ends of the spectrum of Do Not Resuscitate (DNR) orders. I have staff that resuscitate when a DNR is in place as well as staff that do not resuscitate when a DNR is not in place.
-Staff refusing treatment to patients without first confirming insurance coverage as well as requiring HIV clearances.
-Unauthorized pro bono treatment and installment payments on prescriptions.
-Unnecessary treatments being performed
Second, get the facts. To some extent the facts speak for themselves. Staff is acting on their individual code of ethics without regard or possibly without knowledge of the hospitals code. With respect to the DNR issues, in all cases the family members were happy, but in this case, as administrator their happiness is not the issue. The legality however is. DNR orders are for the protection of the hospital and its staff. If they are not adhered to that protection is none existent.
What are the facts surrounding treatment or lack thereof? Investigation again reveals varied results. I have staff that fear for their personal safety, so they require HIV clearance before treatment. I have staff that is concerned for the welfare of the hospital, so they require insurance verification prior to treating. I have staff that care for the patients themselves so much they provide free service or payment on installments, both occurring without consent of administration. I also have staff the order treatment just for the sake of doing the procedure.
Third, evaluate the alternative actions from various moral perspectives. While the hospital mission to promote the health and well-being of the people in the communities we serve must remain a focal point, as administrator the overall health of the organization falls to me. The decision on what treatment should be given should be at the discretion of the physician. The physician must not abuse this authority by ordering those treatments that are not necessary for the welfare of the patient. Even though I can appreciate and even respect the values presented by the staff the truth of the situation is that not everyone is going to be happy. What is going to promote the common good for all concerned? This becomes the question to answer.
Fourth, make a decision. The number decision is the development of policies and procedures that address the identified issues. With regard to:
-DNR orders: Once the policy is written concerning implementation of DNR orders, staff in positions to implement these orders will receive written copies of the policy at a mandatory training session. Each staff member will also be required to sign and acknowledgement form indicating receipt of the policy and personal accountability should policy not be adhered to.
-Refusal to treat. In addition to the newly developed policies and procedures a new department will be created. The sole function of this department is to determine insurance eligibility. If the patient does not have insurance, it will be determined if they are eligible for state or federal aide. If it is determined they are rejected in both arenas and their injuries are not life threatening, they will not be treated. Training will be held to address both insurance issues and personal safety issues.
-Treatment in general. All staff will be required to sign an acknowledgement as to hospital policy regarding non-emergency treatments. This policy will address: unnecessary procedures, when and if pro bono services will be allowed, as well as acceptable financial agreements with the hospital.
Fifth, act, and then reflect on the decision later. Consistent reevaluation of all new policies will be essential. Through their monitoring, I will be able to identify problem areas as they arise and fine-tune the process to deal with them. The decision making process is constant. In order to maintain the health of an organization the process must remain fluid. This is mandated by the one constant in every workplace. THINGS CHANGE!
Utilizing the five steps outlined in the Santa Clara University website, article A Framework for Ethical Decision Making, allowed Faith Community Hospital to benefit from a good ethical decision. While all concerned my not is happy with the outcome, the guesswork has been eliminated providing for more consistent and I believe better treatment for the community being served by FCH. Training will be ongoing, as will the evaluation of the decision making process, allowing for changes to be made quickly.
A Framework for Ethical Decision Making. Retrieved April 21, 2002 from the World Wide Web: http://www.scu.edu/SCU/Centers/Ethics/practicing/decison/framework.html
What is Ethics? Retrieved April 21, 2002 from the World Wide Web: http://www.scu.edu/SCU/Centers/Ethics/practicing/decison/whatisethics.html
Shanks, T. Everyday Ethics. Issues in Ethics- V.8, N.1. Retrieved April 21, 2002 from the World Wide Web: http://www.scu.edu/SCU/Centers/Ethics/publications/iie/v8n1/everydayethics.html