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2 DOING THE RIGHT THING Ethical Behavior and Social Responsibilities in Today’s Health Care Workplace
Starting Point
Go to www.wiley.com/college/Lombardi to assess your knowledge of the basics of ethics in health care. Determine where you need to concentrate your effort.
What You’ll Learn in This Chapter ▲ Common types of ethical dilemmas ▲ Four ways to respond to ethical dilemmas ▲ Common rationalizations for unethical behavior ▲ Three influences on a person’s ethics ▲ Three ways to encourage high ethical standards ▲ Socially responsible responses to difficult situations
After Studying This Chapter, You’ll Be Able To ▲ Demonstrate ethics and socially responsible behavior ▲ Analyze typical ethical dilemmas ▲ Practice health care-specific ethical considerations ▲ Use the seven-step process for ethical decision making ▲ Compare the three common influences on an individual’s ethics ▲ Distinguish between ethics and social responsibility ▲ Examine ways to incorporate social responsibility into today’s workplace
Goals and Outcomes ▲ Master the terminology related to ethical and socially responsible behavior ▲ Recognize common ethical dilemmas and responses ▲ Compare the four views on ethical behavior ▲ Analyze the reasons behind an ethical choice ▲ Formulate ethical responses ▲ Propose ways to encourage high ethical standards and behavior ▲ Evaluate ethical dilemmas and possible responses
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2.1.1 IDENTIFYING ETHICAL DILEMMAS 33
INTRODUCTION Often ambiguous and unexpected, ethical dilemmas are part of the challenge of working in today’s health care organization. While individuals approach ethical questions differently and generate their own unique responses, a basic framework for ethical decision making does exist and can be a useful tool for health care man- agers. Throughout the decision-making process, managers need to be aware of what influences their ethics. Proactive managers can establish and encourage high ethi- cal standards. Socially responsible behavior extends beyond ethics, encouraging health care managers to make a difference in patients’ lives and the world at large.
2.1 Acting Ethically
Ethics are a collection of moral principles that set standards of good or bad, or right or wrong, in one’s conduct and thereby guide the behavior of a person or group within an organization.1 Ethics help people make choices among alterna- tive courses of action. Ethical behavior is what is accepted to be “good” and “right” as opposed to “bad” or “wrong” in the context of the governing moral code. For example, is it ethical to
▲ take longer than necessary to do a job? ▲ make personal telephone calls on company time? ▲ call in sick and then take the day off for leisure activities? ▲ fail to report rule violations by a co-worker?
None of these acts is strictly illegal, but many people consider one or more of them to be unethical. Indeed, most ethical problems arise when people are asked to do something that violates their personal conscience.
For some people, if an act is legal, they proceed with confidence. For others, however, their ethical tests go beyond legality, extending to a question of personal values (or morals)—the underlying beliefs and attitudes that help determine indi- vidual behavior. Because values vary among people, different people interpret sit- uations differently and may consider the same behavior ethical or unethical.
2.1.1 Identifying Ethical Dilemmas
An ethical dilemma is a situation that requires you to make a choice or take action that, although offering the potential for personal or organizational benefit, may be considered unethical. In ethical dilemmas, action often must be taken, but there isn’t a clear consensus on what is right and wrong. In these murky situations, you bear the burden of making good choices. One manager, speaking from experience, sums up ethical dilemmas this way: “I define an unethical situation as one in which I have to do something I don’t feel good about.”2
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Many managerial decisions have ethical overtones. Some areas where man- agers can feel caught in ethical dilemmas (and even cross the line into questions of legality) include3
▲ discrimination: For example, a manager denies promotion or appoint- ment to a job candidate because of the candidate’s race, religion, gender, age, or other non-job-related criterion;
▲ sexual harassment: A manager makes a co-worker feel uncomfortable with inappropriate comments or actions regarding sexuality;
▲ conflicts of interest: A manager takes a bribe—perhaps money or an extra- ordinary gift—in return for making a decision favorable to the gift giver;
▲ organizational resources: A manager uses company stationery or an e-mail account to communicate personal opinions or requests to community organizations.
Additionally, the health care field has its own set of ethical considerations that other managers and workers in other businesses or professions may not encounter. While each health care organization has unique organizational val- ues (refer to your organization’s mission statement or other literature for specifics), most health care organizations affirm the following as part of their organizational ethic:
▲ Care: Whether you’re processing insurance claims or preparing a patient for knee surgery, care means providing health services to patients with an added human touch element. All health care staff should demonstrate care when dealing with each consumer.
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F O R E X A M P L E
Most Common Ethical Dilemmas In a survey of Harvard Business Review (http://harvardbusinessonline.hbsp. harvard.edu) subscribers (which included both business and health care lead- ers), many of the ethical dilemmas reported by managers involved conflicts with superiors, customers, and subordinates.4 The most frequent issues involved dishonesty in communications with top management, clients, and government agencies. Problems in dealing with special gifts, entertainment, and kickbacks were also reported. Significantly, the managers’ bosses were singled out as sometimes pressuring their subordinates to engage in such unethical activities as supporting incorrect viewpoints, signing false documents, over- looking the boss’s wrongdoings, and doing business with the boss’s friends.
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2.1.2 APPROACHING ETHICAL CHOICES DIFFERENTLY 35
▲ Concern: The staff should show concern not only to patients and their physical, emotional, and mental well-being, but also to each other. Staff should be concerned about the wellness and development of fellow employees, helping each other through crises as well as sharing in the joy of daily victories.
▲ Compassion: Compassion is a cornerstone of successful health care orga- nizations and should be present at all levels—including in interactions with patient-consumers and co-workers.
▲ Community: A sense that “we’re all in this together” is helpful in better- ing the health of patients—and it comes in quite handy when working with others on a team or department.
▲ Confidentiality: While federal and state laws—as well as organizational guidelines—spell out in detail who is allowed to know personal, health care-related information, there are appropriate times to share information, as well as to protect others’ privacy.
2.1.2 Approaching Ethical Choices Differently
Figure 2-1 shows four alternative views of how people make ethical decisions and how they behaved in an ethical manner.5 None of these four viewpoints on ethics is necessarily better; the differences simply reflect how complex the question of ethical behavior is and how different people may evaluate the same situation and end up with different ethical responses.
▲ Utilitarian view: the utilitarian view of ethical behavior focuses on deliv- ering the greatest good to the greatest number of people. Also known as
Moral-rights view Does a decision or
behavior maintain the fundamental rights of
all human beings?
Utilitarian view Does a decision or
behavior do the greatest good for the most people?
Individualism view Does a decision or behavior promote one’s long term self-interests?
Justice view Does a decision or
behavior show fairness and impartiality?
Four views of ethical behavior.
Figure 2-1
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results-oriented point of view, this ethical standpoint tries to assess the moral implications of a decision in terms of its consequences.
Decision makers in business—including top management in today’s health care organizations—often use profits, efficiency, and some other performance criteria to judge what is best for the most people in the organization. For example, the manager of a 24-hour pharmacy may make the utilitarian decision to eliminate one full-time pharmacist from her staff in order to keep her pharmacy profitable and save jobs for the remaining staff of 20 pharmacists, technicians, and cus- tomer service representatives.
▲ Individualism view: The individualism view of ethical behavior is based on the belief that your primary commitment is to the advancement of your long-term self-interests. If self-interests are pursued from a long- term view, the argument goes, such things as lying and cheating for short-term gain should not be tolerated.
For example, a call center manager may set up a training plan that is based pri- marily on his workers’ decision to improve their customer-service skills. The manager asserts that anyone who truly wants to do a good job as a phone rep needs to take the personal responsibility to improve themselves.
While the individualism view is supposed to promote honesty and integrity, it can backfire in today’s demanding health care economy. Individualism can result in an environment where individuals stretch the limits of laws, disregard rules that aren’t agreeable or easy, or aggressively compete with one another for supremacy.6
▲ Moral-rights view: the moral-rights view of ethical behavior respects and protects the fundamental rights of people. Decisions are made in response to an ideal or moral, not based on personal or individual circumstances.
In the United States, for example, the rights of all citizens to life, liberty, and fair treatment under the law are considered inviolate. All laws in the United States must mesh with these ideals. In health care organizations today, this concept extends to ensuring that employee rights—such as the right to privacy, due process, free speech, free consent, safety, and freedom of conscience—are always protected. For example, a manager can put in place regulations about when employees are allowed to converse about nonwork matters, but the regulations cannot violate employee’s rights to free speech, as guaranteed in the U.S. Bill of Rights.
▲ Justice view: The justice view of ethical behavior is based on the belief that all ethical decisions should treat people impartially and fairly, accord- ing to guiding rules and standards. This approach evaluates the ethical
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2.1.3 RATIONALIZING UNETHICAL BEHAVIOR 37
aspects of any decision on the basis of whether it is “equitable” for every- one affected.
Several principles follow this line of ethical thinking, including
▲ all policies and rules are to be fairly administered. For example, a sexual harassment charge against a senior executive should receive the same full hearing as one made against a shift supervisor;
▲ people should be treated the same regardless of individual character- istics based on ethnicity, race, gender, age, or other particular criteria. For example, a woman with the same qualifications and experience as a man should receive the same consideration for a promotion;
▲ others should be treated with dignity and respect. For example, a supervisor should take the time to fully explain to a team member why he or she was not selected for a special training program.7
2.1.3 Rationalizing Unethical Behavior
Why might otherwise reasonable people act unethically? Take a look at some of the ethical scenarios described in the preceding sections and think about exam- ples from your experiences. Consider the possibility of being offered money to alter a patient’s medical records. Perhaps the patient is requesting the change so he can be considered for an experimental treatment, or perhaps the patient wants to receive a larger reimbursement from his health insurance provider. Whatever the case, falsifying medical records is a violation of federal law, as well as con- tradictory to many people’s moral codes. And yet, unethical behavior happens all the time in today’s workplace.
At least part of the answer for why people behave unethically at times can be found in the way people rationalize their unethical choices. At least four justifications are commonly asserted to rationalize behavior:8
▲ “My behavior is not really illegal.” This rationalization expresses a mis- taken belief that one’s behavior is acceptable, especially in ambiguous conditions. When dealing with “shady” or “borderline” situations in which you are having a hard time precisely defining right from wrong, the advice is quite simple: When in doubt about a decision to be made or an action to be taken, don’t do it.
▲ “My behavior is really in everyone’s best interests.” This response involves the mistaken belief that because someone can be found to bene- fit from the behavior, the behavior is also in the individual’s or the orga- nization’s best interests. Overcoming this rationalization depends in part on the ability to look beyond short-term results to address longer-term implications. It also requires looking beyond results in general to the ways in which they are obtained.
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▲ “Nobody will ever find out what I’ve done.” Sometimes rationalizers mistakenly believe that a questionable behavior is really “safe” and will never be found out or made public. Unless it is discovered, the argument implies, no wrong was really committed. Lack of accountability, unrealis- tic pressures to perform, and a boss who prefers “not to know” can all reinforce such thinking. In this case, the best deterrent is to make sure that everyone knows that wrongdoing will be punished whenever it is discovered.
▲ “My company/boss/organization will protect me.” This rationalization is misperceived loyalty. You believe that the organization’s best interests stand above all others. In return, you believe that top managers will con- done your behavior and protect you from harm. Again, the advice is straightforward: Loyalty to the organization is not an acceptable excuse for misconduct.
2.1.4 Making Ethical Decisions
Numerous guidelines for making ethical decisions exist, but the following seven- step process offers a convenient, concise method for confronting ethical dilem- mas. For more information on the process of making decisions, see section 8.1.
In particular, the following process serves as a reminder that good decision making typically involves double checking before taking action. For example, the key issue in the checklist may well be Step 6, which requires you (and the orga- nization you’re making decisions for) to essentially “look in the mirror” and evaluate the risk of public disclosure of your action and your willingness to bear it.9
Step 1: Recognize the ethical dilemma.
Step 2: Get the facts.
Step 3: Identify your options.
Step 4: Test each option: Is it legal? Is it right? Is it beneficial?
Step 5: Decide which option to follow.
Step 6: Double-check your decision by asking two questions:
“How would I feel if my family found out about my decision?”
“How would I feel about this if my decision were printed in the local newspaper?”
Step 7: Take action.
Be sure to turn to Chapter 8 for more information on the process of making decisions within a health care organization.
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2.2.1 PERSONAL INFLUENCES 39
2.2 Identifying Ethical Influences
Confronting ethical dilemmas from the safety of a textbook or a college class- room is almost too easy. In the real world, you are often challenged to choose ethical courses of action in situations that arise unexpectedly. The pressures to respond or act may be contradictory and great.
As shown in Figure 2-2, three main influences affect your ability to make ethical choices.
2.2.1 Personal Influences
Family influences; religious values; personal standards; and personal needs, financial and otherwise, all help determine your ethical conduct in any given cir- cumstance.
The person
• Family influences • Religious values • Personal standards and needs
Employing organization
• Policies, codes of conduct • Behavior of supervisors, peers • Organizational culture
External environment
• Government regulations • Norms and values of society • Ethical climate of industry
Ethical behavior in the workplace
Factors influencing ethical behavior at work.
Figure 2-2
• Identify and define ethical behavior, ethical dilemma, ethics, and personal values.
• List common ethical dilemmas.
• Discuss health care-specific ethical responses.
• Distinguish among the four most common ethical views: utilitarian, individualism, moral rights, and justice.
• Describe common rationalizations for unethical behavior.
• Explain a seven-step process for making ethical decisions.
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Managers who lack a strong and consistent set of personal ethics find that their decisions vary from situation to situation as they strive to maximize self- interests or please an ever-changing roster of supervisors and co-workers. Those who operate with strong ethical frameworks, positive personal rules or morals, or strategies for ethical decision making are more consistent and confident because their choices are made against a stable set of ethical standards.
2.2.2 Organizational Influences
The organization itself is another source of important influences on your ethical choices at work. Your supervisors can affect your behavior significantly. For exam- ple, what exactly a supervisor requests and the ways in which certain actions are rewarded or punished in an organization affect your decisions and actions. For example, if no one has ever been promoted to floor nurse in your organization without dumping difficult patients on newer staff members, you are more likely to burden lesser-experienced staff with tough cases in an effort to prove you’d be a good candidate for floor nurse.
Similarly, the expectations and reinforcements provided by your peers and group norms are likely to affect your behavior, and ultimately your ethics. For example, if asking for help when you become overwhelmed with end-of-the- month invoices is considered a sign of weakness in the medical billing office you work in, you’re much less likely to assist an overwhelmed co-worker or to ask for an hour or two of assistance for yourself.
Formal policy statements and written rules, although they cannot guarantee results, are also very important in establishing an ethical climate for the organi- zation as a whole. They support and reinforce the organizational culture, which can have a strong influence on your ethical behavior.
Ethics training—structured programs to help participants understand the ethical aspects of decision making—can help people incorporate high ethical standards into their daily behaviors.
However, the purpose of ethics training must be kept in perspective. Most ethics training programs focus on dramatized dilemmas in which participants brainstorm and discuss possible responses. The focus of most training is on help- ing people deal with ethical issues while under time or financial pressure—and to avoid the four common rationalizations for unethical behavior discussed in the section 2.1.3.
Senior health care managers have the power to shape the entire organiza- tion’s policies and set its ethical tone. They can and should serve as models of appropriate ethical behavior for the entire organization. Not only must their day- to-day behavior be examples of high ethical conduct, but top managers must also regularly communicate similar expectations throughout the organization.
However, the responsibility to “lead by example” in regards to high ethical standards is not only top management’s responsibility. All managers at all levels in
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2.2.2 ORGANIZATIONAL INFLUENCES 41
all organizations are in positions to influence the ethical behavior of the people who work for and with them. Every manager is an ethical role model and must always bear this in mind when making decisions and interacting with others.
Codes of ethics are official written guidelines on how to behave in situa- tions where ethical dilemmas are likely to occur. The codes of ethics for many health care organizations mirror the code of ethics of the medical professions. Within medical professions, ethical codes try to ensure that individual behav- ior is consistent with the historical and shared norms of the professional group.
Items frequently addressed in codes of ethics include
▲ workforce diversity; ▲ bribes and kickbacks; ▲ political contributions and activities; ▲ the honesty of records and patient information; ▲ appropriate employee relationships with patients; ▲ confidentiality of patient information; ▲ confidentiality of organizational information.
Although interest in codes of ethical conduct is growing, codes cannot cover all situations, and they cannot guarantee universal ethical conduct. The value of any formal code of ethics still rests on the underlying human resource foundations of the organization—its managers and other employees.
There is no replacement for effective hiring practices that staff an organiza- tion with honest and moral people. And there is no replacement for the leader- ship of committed managers who are willing to set the examples and act as eth- ical role models to ensure desired results.
F O R E X A M P L E
Answering Ongoing Ethical Questions at Beth Israel Beth Israel Deaconess Medical Center (www.bidmc.harvard.edu) in Boston has responded to the ethical concerns of its patients, families, and staff by establishing the BIDMC Ethics Support Service. Medical personnel can con- tact a toll-free number 24 hours a day, 7 days a week and discuss ethics questions in a supportive manner. Following formal consultation, the ser- vice notes its assessment and recommendations in a patient’s medical records, but any final decisions are the responsibility of the attending physi- cian and patient. Additionally, the team also holds regular “ethics rounds” in which staff gathers to discuss recent ethical questions at Beth Israel and other health care organizations worldwide.
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2.2.3 Environmental Influences
As section 1.1 discusses, all organizations operate in external environments, which include competitors, government laws and regulations, and social norms and values, among other influences. Laws interpret social values to define appro- priate behaviors for organizations and their members; regulations help govern- ments monitor these behaviors and keep them within acceptable standards.
The climate of competition in an industry also sets a standard of behavior for those who hope to prosper within it. Sometimes the pressures of competi- tion contribute further to the ethical dilemmas of managers. Outside groups and stakeholder organizations can also influence the ethical environment.
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2.3 Taking Social Responsibility
Concerns for ethical behavior must extend beyond the behaviors of individual workers and managers. Ethical concerns must also apply to the organization as a whole. Chapter 1 describes the environment of a health care organization as a network of other organizations and institutions with which it must interact.
Social responsibility is defined by health care organizations and other busi- nesses in a variety of ways, including concerns for ecology and environmental quality, patient care and protection, and ongoing aid in community education. Many health care organizations also include direct service to community needs, positive employment practices, positive diversity practices, progressive labor rela- tions, employee assistance, and general corporate philanthropy, as part of their social responsibility.
Regardless of the activities an organization considers as part of its social responsibility, social responsibility in the broadest sense is an obligation of the organization to act in ways that serve both
▲ its own interests and ▲ the interests of individuals and groups affected by the behavior of an
organization.
• Identify and define ethics training and code of ethics.
• Compare the three types of ethical influences: personal, organiza- tional, and environmental.
• Describe three ways organizations attempt to influence and encour- age ethical behavior.
• List topics that are frequently covered by formal codes of ethics.
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2.3.2 PUTTING SOCIAL RESPONSIBILITY INTO ACTION 43
2.3.1 Making the Case for Social Responsibility
Organizations choose to be socially responsible for various reasons, including some or all the following:
▲ People do their best in healthy work environments that permit job involvement, respect for contributions, and a good balance of work and family life.
▲ Organizations function best over the long run when located in healthy communities with high qualities of life.
▲ Organizations realize performance gains and efficiencies when they treat the natural environment with respect.
▲ The reputation of an organization must be protected to ensure consumer and stakeholder support.
The public at large now expects health care organizations to act with genuine social responsibility and to integrate social responsibility into their core values and daily activities. And on the business side of health care organizations, the argument that social responsibly efforts negatively affect the organization’s bottom line is hard to defend. Increasing evidence shows that socially responsible orga- nizations also exhibit strong financial performance (and, at worst, socially respon- sible organizations experience no adverse financial impact). Businesses can serve the public good as well as a broad pool of stakeholders (including financial share- holders).
2.3.2 Putting Social Responsibility into Action
Some health care organizations perform a social audit to report on and sys- tematically assess an organization’s commitments and accomplishments in the areas of social responsibility. Often conducted at regular intervals—annually, every other year, or every 5 years are common intervals—social audits give orga- nizations a sense of how well they’re meeting their socially responsible goals and how their contributions compare to other similar organizations.
Social audits typically cover four areas of organizational responsibility (as you move down the list, the types of responsibilities become increasingly socially responsible):
▲ Economic responsibility: A for-profit organization meets its economic responsibility when it earns a profit by selling a certain amount of goods and services, thus satisfying investors’ expectations. A not-for-profit orga- nization meets its economic responsibility when it earns enough money to fully pay for its programs, employees, and long-term endowment investments.
▲ Legal responsibility: When an organization operates within the law (includ- ing federal, state, and local regulations), its meets its legal responsibility.
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▲ Ethical responsibility: An organization meets its ethical responsibility when its actions voluntarily conform not only to legal expectations but also to the broader values and moral expectations of society.
▲ Discretionary responsibility: The highest level of social performance comes through the satisfaction of an organization’s discretionary respon- sibility. Here, the organization voluntarily provides leadership in advanc- ing the well-being of individuals, communities, and society as a whole.10
2.3.3 Obeying the Law
Governments often pass laws and establish regulatory agencies to ensure that organizations act responsibly. You probably know these agencies best by their acronyms: FAA (Federal Aviation Administration), EPA (Environmental Protec- tion Agency), OSHA (Occupational Safety and Health Administration), and FDA (Food and Drug Administration), among many others.
Executives within the business community and the health care industry some- times complain that laws and regulatory agencies are overly burdensome. Many express concerns that regulations raise costs by increasing the paperwork and staff necessary to comply with regulations. Many executives feel that regulation diverts their attention from important productivity, profit, or patient-consumer concerns.
In reality, the legal environment is both complex and constantly changing. Many themes discussed as being key areas of social responsibility in this chap- ter are backed by major federal, state, and local laws. Managers must stay informed about new and pending laws, as well as existing ones.
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F O R E X A M P L E
Global Alliance for Vaccines and Immunization The Global Alliance for Vaccines and Immunization (GAVI) began in 2000 as a coalition of private, public, and governmental groups united by an overar- ching mission to “save children’s lives and protect people’s health through the widespread use of vaccines.” To meet a complex array of economic, legal, eth- ical, and discretionary responsibilities, GAVI relies on an executive board to set policies of its numerous working groups worldwide. Five renewable mem- bers (WHO, UNICEF, the World Bank, the Bill & Melinda Gates Foundation, and the Vaccine Fund), along with 12 rotating members with medical, finan- cial, and/or philanthropic expertise, regularly meet and discuss how to bal- ance GAVI’s inspiring global vision with its demanding financial needs. The board’s decisions are frequently published online at www.vaccinealliance.org.
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2.3.4 MAKING THE DIFFERENCE—ONE MANAGER AT A TIME 45
As a reminder of the positive side of legislation, consider a few examples of how the U.S. government takes an active role in regulating businesses, includ- ing health care organizations.
▲ Occupational safety and health: The Occupational Safety and Health Act of 1970 firmly established that the federal government was concerned about worker health and safety on the job.
▲ Fair labor practices: The Equal Employment Opportunity Act of 1972 and many following regulations are designed to eliminate discrimination in labor practices based on race, gender, age, national origin, and marital status.
▲ Consumer protection: The Consumer Product Safety Act of 1972 gives government authority to examine and force a business to withdraw from selling any product that it feels is hazardous to the consumer.
▲ Environmental protection: The Air Pollution Control Act of 1962 was the first in a series designed to eliminate careless pollution of the air, water, and land.
2.3.4 Making the Difference—One Manager at a Time
As public demands grow for organizations to be accountable for ethical and social performance, the manager stands in the middle. A manager’s decisions affect quality-of-life outcomes in the critical boundaries between people and organiza- tions and between organizations and their environments. Everyone must be more than willing to increase the weight given to ethical and social responsibility con- siderations when making decisions.
Figure 2-3 presents the manager’s or team leader’s challenge this way: to ful- fill accountabilities for achieving performance objectives, while always doing so
Performance with • High ethical standards • Social responsibility
Accountability
Dependency
Leader
Higher Management
Figure 2-3
Central nature of ethics and social responsibility in leadership and the managerial role.
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in an ethical and socially responsible manner. The full weight of this responsi- bility holds in every organizational setting—small to large, private or public, for- profit or not-for-profit. There is no escaping the ultimate reality: being a man- ager is a very socially responsible job!
Today’s health care workplace expects and demands managers who fully accept the responsibilities of ethical leadership, which is moral leadership that meets the test of being “good” rather than “bad,” and “right” rather than “wrong.” Trends in the evolution of social values point to ever-increasing demands from governments and other stakeholders that managerial decisions reflect ethical as well as high-performance goals. Today’s workers and managers, as well as tomor- row’s, must accept personal responsibility for doing the “right” things. Broad social and moral criteria must be used to examine the interests of multiple stake- holders in this dynamic and complex environment.
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SUMMARY Not only must today’s health care managers strive to manage people and processes for maximum productivity, these individuals must also be ethical lead- ers for their staffs and organizations. Ethical dilemmas abound in today’s work- place, but managers can still respond to situations ethically, based on various ethical viewpoints and standardized decision-making processes. While a person’s ethics and morals are affected by his or her personal background and overarch- ing environmental influences, organizations can also influence ethical behavior through ethics training, ethical leadership, and codes of ethics. Social responsi- bility takes ethics a step further, requiring organizations to act in ways that are legally appropriate and encourage the well-being of individuals, communities, and society as a whole.
• Identify and define social responsibility and social audit.
• List reasons for organizations to act in a socially responsible manner.
• Describe the four areas typically covered in a social audit.
• Identify major laws and governmental organizations that impact an organization’s social responsibility.
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KEY TERMS 47
KEY TERMS Codes of ethics Official written guidelines on how to behave in situa-
tions where ethical dilemmas are likely to occur.
Ethical behavior What is accepted to be “good” and “right” as opposed to “bad” or “wrong” in the context of the governing code.
Ethical dilemma A situation that requires you to make a choice or take action that, although offering the potential for per- sonal or organizational benefit, may be considered unethical.
Ethics Collection of moral principles within a group or or- ganization that set standards of good or bad, or right or wrong, for one’s conduct.
Ethics training Structured programs to help participants understand the ethical aspects of decision making.
Individualism view Based on the belief that your primary commitment is to the advancement of your long-term self-interests.
Justice view Based on the belief that all ethical decisions should treat people impartially and fairly, according to guid- ing rules and standards
Moral-rights view Respects and protects the fundamental rights of peo- ple. Decisions are made in response to an ideal or moral, not based on personal or individual circum- stances.
Personal values Morals, or the underlying beliefs and attitudes that help determine individual behavior.
Social audit A systematic assessment of an organization’s commit- ments and accomplishments in the areas of social re- sponsibility.
Social responsibility Having concern for issues beyond business-related issues, including ecology and environmental qual- ity, patient care and protection, and community involvement.
Utilitarian view Also known as results-oriented point of view, this ethical standpoint tries to assess the moral implica- tions of a decision in terms of its consequences.
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ASSESS YOUR UNDERSTANDING Go to www.wiley.com/college/Lombardi to evaluate your knowledge of the basics of ethics in health care. Measure your learning by comparing pretest and post-test results.
Summary Questions
1. The only purpose of ethics is to help people determine whether an action is legal and illegal. True or false?
2. Ethical dilemmas frequently involve questions regarding (a) conflicts of interest. (b) use of company resources. (c) preferential treatment. (d) all of the above.
3. Many health care organizations have an organizational ethic that relates to how patients are treated. This ethic relates to (a) confidentiality. (b) care. (c) concern. (d) community.
4. An individualism view of ethics can promote honesty and integrity in the workplace, but it can also lead to disregard for rules that aren’t agreeable with the individual. True or false?
5. Laws and regulations are what type of ethical influence? (a) Personal (b) Organizational (c) Environmental (d) Legal
6. Personal influences on ethical choices can include all of the following except (a) financial needs. (b) employee handbook. (c) family influences. (d) religious beliefs.
7. “Leading by example” is largely the responsibility of upper management in a health care organization. True or false?
8. Each organization defines social responsibility for itself, often including concerns, employment equality, labor relations, and corporate philanthropy. True or false?
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9. One reason organizations should choose to be socially responsible is that (a) organizations function best over the long run when located in
healthy communities. (b) organizations are held accountable by the EPA for environmental
damage. (c) organizations owe their employees the best possible work environment. (d) organizations grow more quickly when they are profitable.
10. Social audits compare an organization’s code of ethics with other similar organizations, attempting to determine the best possible plan for going forward. True or false?
11. Previous governmental legislation has encouraged organizations to act in a socially responsible manner in which of the following areas? (a) Environmental protection (b) Fair labor practices (c) Occupational health and safety (d) All of the above
Review Questions
1. A health care worker shares patient information with a pharmaceutical representative to assist the rep in putting together a survey that could potentially help the patient gain access to a new drug. What sort of ethi- cal dilemma is the worker engaged in?
2. Using greater profits and efficiency to justify a difficult decision is typical of what ethical viewpoint?
3. You routinely take paper towels for personal use from your department’s supply room because you know that no one really monitors the inventory for paper products. What rationalization are you engaging in?
4. What are three questions that you can use to test your options in ethical decision making?
5. In addition to laws and regulations, what are some environmental influ- ences on ethical behavior?
6. Where might an employee turn for help dealing with questions of whether he or she can make a contribution to a political party?
7. What are some appropriate topics for an organization’s formal code of ethics to address?
8. In the broadest sense, social responsibility is an obligation of an organization to serve the interests of what two groups?
9. What four areas of social responsibility do social audits usually pay attention to?
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10. In what ways is discretionary responsibility the highest level of social responsibility?
11. Which governmental agencies help ensure that organizations act in a socially responsible manner?
Applying This Chapter
1. A drug-treatment program’s mission statement says that “every human being has the right to live free from addictions and chemical vices.” Consider the ethics that support this mission statement. Which ethical viewpoint does this mission statement align with?
2. A medical assistant at an in-house corporate health center frequently helps workers pass annual drug screenings by altering urine samples. The assistant feels that drug-screening is unnecessary because no employees operate heavy machinery or do anything that risks the lives of themselves or others. Besides, the assistant reasons that what workers do on their own time is their personal business. What type of rationalization for unethical behavior is the assistant using?
3. When the CEO of an insurance company states in an interview that her company will not share customer information with a direct marketing firm, even though the relationship could be profitable for the insurance company, how is the CEO helping maintain high ethical standards?
4. A nursing home’s annual report to patients and their families notes that the facility has operated debt and litigation-free for the last 16 years, although many of its competitors have accrued significant financial liabil- ity and entered into expensive lawsuits. What two levels of organizational responsibility is the facility highlighting?
5. You manage a team of customer service representatives at an insurance call center. Several on your team have been complaining about new fed- eral restrictions on privacy and the additional paperwork they must process for each claim. How might you respond to these team members, letting them know the importance and necessity of complying with the new laws?
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YOU TRY IT
ID Chip Ethics For years, people with life-threatening allergies or dis- eases have worn metal identification necklaces or bracelets to alert emergency caregivers to special medical conditions. Several technology firms recently began offering embeddable microchips that do the same job as wearable ID While potentially lifesaving, embeddable chips can also give hospitals instant ac- cess to much more patient information, including per- sonal and financial data. An organization of emergency physicans formally supported the ID chips, taking a utilitarian view and saying that the benefits of ID chips to provide life-saving emergency medical care out- weigh the potential risk of abuse. What would be a positive response based on individualism to the ID chips? What would be a response based on moral rights or justice?
Evaluate a Plan’s Ethics As the manager of a student health clinic on a small college campus, you meet daily with students to dis- cuss and screen for sexually transmitted diseases. In the last month, you and your staff have noted a dra- matic increase in chlamydia cases for students residing in one co-education dorm facility. You and your staff decide to post flyers about the symptoms and risks of chlamydia in the dorm bathrooms and lead a short ed- ucational session during the next all-dorm meeting. Is your plan legal, right, and beneficial? Run through the
seven-step process for ethical decision making, paying particular attention to Steps 4 and 6.
Your Ethical Influences Recall an ethical decision you made in the last year. Per- haps you had to make a difficult choice related to your education, career, employment, or personal life. What were some of the pros and cons of going with the deci- sion you made? What specifically influenced your deci- sion? Were these influences personal, organizational, or environmental? Was there a combination of influences?
Responding with Social Responsibility One technique to encourage socially responsible behav- ior is to utilize a stress-positive approach to dealing with news reports. Television, magazines, newspapers, and online information sources today seem to be filled with potentially alarming information about the state of health care, our government, and the world in general. Rather than letting yourself feel overwhelmed by the informa- tion, ask yourself how these news items might affect your studies, your career goals, or how you do your job. The next time you encounter a potentially alarming news story, remind yourself that news reports are simply infor- mation; you can respond with negative stress (worrying about your job prospects or even distressing about the future of the world), or you can use the information to ed- ucate yourself and help focus your studies or work be- haviors to act in a more socially responsible manner.
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